Fair Funding for Hospices - Hospice UK's four-point plan

Hospices in England are on the brink. Surging costs have led to many services being cut back – just as demand is rising, fast, because of our ageing population. As it stands, two in five hospices in England are planning to make cuts. The situation is not sustainable – and time is running out.

Full funding of specialist palliative care provided by hospices

Whether in inpatient units, in patient’s homes, in outpatient clinics or through in-reach services within hospitals, the specialist palliative care, advice and assessment hospices provide should be fully funded by local NHS commissioners.

Proper NHS contracts for hospices

Too often, the state’s contribution to the cost of hospices’ services are through grants which don’t reflect the true cost, and which are based only on historical precedent.

Hospices should be on NHS contracts which are fair, multi-year, have regular reviews and increase in line with rising costs. These should be based on agreed, national cost models. Contracts should be flexible in response to the changing care needs of a local population and meeting rapidly growing demand.

In addition, the government should continue to provide ringfenced additional funding for children’s hospices (formerly known as the Children’s Hospice Grant), over and above local contracts, recognising the large areas covered by these services.

Why do we need fair funding for hospices?

Hospices in England provide care for 270,000 people each year – sometimes in inpatient units, but more often, in people’s homes. The holistic care they provide includes highly specialist palliative and end of life care. Hospices also support tens of thousands of families and loved ones each year, including with bereavement support.

The majority of this care is funded by charity – marathon runs, gifts in wills, and charity shops. In fact, in England, on average, the NHS only funds around 40% of the care that a hospice provides.

And while hospices are providing services on behalf of the NHS that are required by law, they rarely have proper contracts with local Integrated Care Boards to do so. These contracts too often don’t reflect the actual costs of delivering the service. Hospices also need to keep pace with NHS pay in order to recruit nurses and doctors – but do not receive any additional funding to do so when NHS pay increases. This isn’t fair.

Charitable income will always play a vital role in hospice care. It’s what allows hospices to deliver exceptional, holistic care that goes beyond NHS provision, and it creates a precious link with the local community. We know that services funded by charity – like living well services, and compassionate communities schemes – are helping to keep people out of hospital.

But with our population ageing, and death rates set to increase rapidly in the coming years, the hospice funding model is no longer fit for purpose. It’s not acceptable that vital palliative care services are reliant on charity – meaning wealthier areas are more likely to be able to fund them, and an estimated one in four people who need specialist palliative care are not getting it. The Secretary of State for Health and Social Care has himself said he is not comfortable with this model.

And, now, with assisted dying looking likely to be introduced, we have to ask ourselves whether it’s fair for the state to fund an assisted dying service, while essential care for the dying relies on second-hand clothes sales.

That’s why, in response to the Ten-Year Plan for Health, we are calling for fair funding for hospices.