The NAO argues that the government lacks clarity on the impact of its funding for independent adult hospices as demand rises for palliative and end-of-life care.
The National Audit Office (NAO) has said that the Department for Health and Social Care (DHSC) and NHS England (NHSE) do not clearly understand what proportion of palliative and end-of-life care is delivered by independent adult hospices, and therefore, how much they are reliant on the sector, or what the real impact of government funding is.
With the demand for palliative and end-of-life care anticipated to rise in line with an expected increase in the number of older people in England dying or choosing to spend the end of their lives under the care of a hospice, further pressure will be placed on the financial resilience of the sector.
Funding from Integrated Care Boards (ICBs), through grants or contracts, met 40% of independent adult hospices’ expenditure on services in 2023-24, equating to over £400 million. But a lack of central oversight from DHSC means it is unclear what this funding is specifically used for, or whether it is sufficient to maintain the sector’s future without more services having to be delivered by the NHS to meet increasing demand.
“Palliative and end-of-life care is not prioritised across England. This report shows how a historic lack of understanding from a national to local level about the care delivered by hospices means they are currently not funded fairly, and it is patients that are paying the price,” said Toby Porter, chief executive of Hospice UK.
Not financially resilient
DHSC and NHSE do not currently know how much palliative and end-of-life care independent adult hospices provide in England, and therefore how reliant they are on the sector, because the way they provide funding to hospices makes it difficult to determine the level of activity delivered, and limited financial and activity data are available.
Although DHSC and NHSE have no statutory responsibility in relation to independent hospices, it is important that hospices are financially sustainable so that they can provide the level of palliative and end-of-life care that DHSC and NHSE rely upon. NHSE has increasingly recognised and increased its role in palliative and end-of-life care in recent years.
Nearly two-thirds of independent hospices reported a deficit in 2023-24, and overall expenditure was £78 million more than the income generated.
In response to this, some hospices have reduced service, and there have been cuts to both beds and staff.
The financial resilience of the independent adult hospice sector faces further challenges due to the declining return on investment from fundraising. A continuation of this downward trend could lead to increased reliance on government funding to provide palliative and end-of-life services.
“With many more people expected to want hospice care in the future, it is crucial that the sector is financially resilient. DHSC and NHSE should assess how they would meet increased demand for palliative and end-of-life care should services delivered by independent adult hospices be insufficient,” said the NAO’s head Gareth Davies.
