Introduction: The closure of Richard House Children’s Hospice in December 2025 represents more than the loss of a single organisation. It signals a moment of reckoning for the children’s hospice movement in the United Kingdom.
Richard House served families in East London for 25 years. East London has a hugely diverse population with some 104 languages and dialects spoken. It has a substantially higher number of children with life limited or threatened lives than any other part of the country. So, Richard House was uniquely placed in the right part of the country. Failing as it has means there are serious questions to be asked.
The Richard House Trust has now entered administration, with the likely sale of its purpose-built building. For families, staff, volunteers and supporters, the loss is deeply personal. For the wider sector, it raises difficult and necessary questions. But at the moment it is a tragedy.
To my knowledge, Richard House is the first children’s hospice in the UK to close. That fact alone requires national reflection. This piece seeks to offer a wider perspective before drawing specific lessons from the experience of Richard House.
Wider Context: A Successful but Fragile Movement
The children’s hospice movement began with Helen House in 1982 and has grown to 54 children’s hospices across the UK. Most are independent charities, locally governed, highly reliant on fluctuating voluntary income, and delivering specialist, emotionally complex care.
Many were founded by parents following the death of a child. This gives them moral authority and authenticity. Yet it also creates structural vulnerability: small organisations delivering high-cost services within increasingly complex regulatory and commissioning environments. National pressures include escalating staffing and regulatory costs, workforce shortages, increasing clinical complexity, volatile voluntary income, uncertain statutory funding, and growing demand, yet challenged with the paradox of underutilised buildings. Richard House is not likely to be the only children’s hospice to face such challenges. Sustainability can no longer be assumed.
A Difficult Question: Is the Model Efficient?
Children’s hospices are expensive to operate, carrying significant overhead costs including senior management, buildings, maintenance and fundraising infrastructure.
Very crudely calculated, 54 hospices with an average income of £5 million represents approximately £270 million nationally. Redirected differently, this level of funding could theoretically support, with the caveat that there would still be a requirement for residential end-of-life and respite services, somewhere between 100-200 fully funded children’s community palliative care teams, to include, medical and nursing staff.
This is a simplistic calculation, but it raises a serious policy question: are we investing in the most equitable and sustainable model of children’s palliative care?
Children’s hospices have sometimes been described as ‘Rolls Royce services for the few.’ Yet those who experience them often say they are worth every penny. The debate is not about value. It is about proportionality, reach and sustainability.
Richard House as a Case Study
Based on what I have understood about the background leading to the closure, the following areas for consideration came up for me:
1. Strategic Scale and Collaboration
Strategic consolidation with nearby hospices might have preserved services while reducing duplication of overheads. Collaboration must happen early before a crisis takes over. I am not fully aware of why a merger was not agreed on. I understand there were attempts but these were resisted. It makes me wonder why the benefits for beneficiaries are not paramount in such deliberations.
2. Governance and Independence
Healthy governance depends on maintaining boundaries between trustees and executive leadership. Boards must combine financial competence, clinical expertise, community representation, safeguarding knowledge and strategic independence. Balance is critical.
3. Organisational Culture
Culture in hospice care is foundational. A toxic culture damages staff morale, fundraising, commissioner relationships and public trust. Values-based recruitment and leadership development are essential safeguards. Historically, the culture at Richard House had always been a noticeable and a positive feature that anyone visiting would comment on. This is especially important for families as they enter a place of safety and respite.
4. Income and Relationships
Hospices require a balanced mix of voluntary and statutory income. Financial sustainability is relational as much as operational. All funders, voluntary and statutory alike are influenced by the quality of the perceived culture.
5. Cost Discipline and Proportionality
Rising costs require scenario planning, shared services and restructuring when necessary. Mission and passion cannot indefinitely compensate for financial imbalance.
The 3-Legged Stool – and a Fourth
Organisational health may be visualised as a stool supported by people, resources and strategy, with the seat representing core purpose.
Richard House’s core purpose was described as:
‘To accompany children, young people and their families from life through death, creating positive experiences along the way to create good memories for the future.’
This resonated compellingly with staff, volunteers and supporters alike. It was a powerful description of the work explaining what the organisation was about in simple terms. The legs of the stool represent critical components but they are there for the seat and nothing else.
If all legs weaken simultaneously, collapse becomes likely. From what I gathered it would appear that a perfect storm developed with the 3 legs badly damaged.
There could be a fourth leg introduced, community engagement, where integrating public health approaches alongside specialist provision could help strengthen the core purpose (see below).
The wider Lesson for the Sector with a new way forward?
The public health approach is an opportunity to reimagine how services are delivered. Within adult palliative care, this is an emerging and transformative model which is gaining attention. Rooted in community engagement, and strengthened by appropriate training and support, it offers a powerful way of mobilising and sustaining local community assets, relationships, and shared responsibility.
Shortly before my retirement, I had the privilege of working with Together for Short Lives, the national body, to develop a project designed to test and explore the potential of this approach. This should be explored further.
As I have reflected, I wonder whether the closure of Richard House should prompt an honest national evaluation, with an opportunity for change across the sector.
A Personal Word
I served as the first Chief Executive of Richard House, setting it up and developing the work for the first 18 years. It was a demanding and hugely rewarding and I felt very privileged to lead the work of the hospice. Over the 25 years it was operational, Richard House made a profound difference to many children, young people and families. My sincere congratulations are offered to the staff and volunteers who carried the hospice through years of service and through its recent darkest days. I salute you. For the many who have lost their livelihoods, I feel for you.
The question now is not whether Richard House was valuable. It is whether we will learn enough from its closure to secure the future of children’s palliative care nationally. I hope so. This is at least the best that can rise from this catastrophe.
Peter Ellis
Former Chief Executive.
Richard House Children’s Hospice
February 2026
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