Responsibility for commissioning and funding hospices

Most hospices were established from charitable and philanthropic donations and are primarily charity-funded and independently run. However, they receive around a third of their income from statutory funding from the NHS and central Government. In England, NHS commissioning of palliative and end of life care, including hospices, is largely the responsibility of Integrated Care Boards (ICBs).

As part of the Health and Care Act 2022, palliative care services were specifically added to the list of services that  ICBs must commission for their local areas.  NHS England has established Palliative and End of Life Care Strategic Clinical Networks, and in July 2022 they published statutory guidance for ICBs on palliative and end of life care. This is intended to ensure a more consistent national approach, and support ICBs to fulfil their legal duty to commission palliative and end of life care services that meet the reasonable needs of their population. The guidance includes specific reference to ensuring that there is sufficient provision of specialist palliative care services, hospice beds and future financial sustainability (see PQ141615, Hospices, 14 February 2023).

In January 2024 the APPG on Hospice and End of Life Care published a report on Government funding for hospices (PDF). The APPG’s inquiry found that despite the introduction of a legal requirement for ICBs to commission palliative and end of life care, ICB commissioning of hospice services is currently not fit for purpose, and the value they provide to individuals and the wider health system is at risk.

In July 2019, it was announced that the Children and Young People’s Hospice Grant would increase from £12 million in 2019/20 to £25 million by 2023/24 (Children’s hospices to receive £25 million a year as part of NHS Long Term Plan). The grant is provided to children’s hospices to compensate for the lower levels of local statutory funding they receive compared to adult hospices. In 2023, NHS England confirmed that it will be renewing this grant funding for 2024/25 (see PQ192460 Hospices: Children, 10 July 2023).

 The Government announced additional funding for hospices during the coronavirus pandemic, and in a Westminster Hall debate on 17 January 2024, the Minister for Social Care, Helen Whately set out some of the wider financial support available to hospices (see Hansard, Hospice Funding: Devon, 17 January 2024). There were also Westminster Hall debates on fiscal support to the hospice sector and increases in the cost of living on 2 March 2023, and on support for hospice services on 16 June 2023).

Calls for more funding

Hospice UK (the national charity for hospice and palliative care) and providers of hospice services, such as the charity Sue Ryder, are campaigning for additional NHS funding, and for the Government to take action to help hospices with rising costs for energy, food and staff pay (see Hospice UK calls for action over rising costs, and Sue Ryder, Fair funding for palliative care).

The Health and Social Care Committee’s report on assisted dying and assisted suicide included chapters on the availability, quality and funding of palliative and end of life care (PEoLC) (see chapter 4). Many witnesses and written evidence submissions to the Committee argued that the funding for specialist PEoLC is insufficient and unsustainable, leading to geographic inequality in access to and quality of care. The Committee said the Government must ensure universal coverage of PEoLC services, including hospice care at home, and also called for an uplift of funding for hospices:

We understand that the flexible nature of the current funding model for hospices is valued by some hospice leaders, and rather than suggesting that the Government funds 100% of hospice operations, we call on the Government to commit to an uplift of funding to guarantee that support will be provided to any hospices which require funding assistance.

[See Health and Social Care Committee, Assisted Dying/Assisted Suicide (HC321, 2023-24, 29 February 2024),  para 280]

The APPG on Hospice and End of Life Care’s report on Government funding for hospices (PDF), published in January 2024, made a number of recommendations to Government, the NHS and local authorities. On funding, the APPG recommended the Government should produce a national plan to ensure the right funding flows to hospices, and conduct or commission a piece of work to understand the costs of providing different models of palliative and end of life care. It also called for Government funding to address immediate pressures of paying increased staffing costs for hospices, and said ICBs must ensure uplifts to hospice contracts are equitable with uplifts received by NHS-run services.

Further information

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