The government has little to no understanding of how reliant it is on independent hospices to support palliative and end-of-life care against a backdrop of increasing demand, and falling funding.
A report by the National Audit Office (NAO) has identified the sector faces significant funding challenges. Charitable donations, fund-raising, legacies and retail activity generate most of the income according to ‘The financial sustainability of England’s adult hospice sector’. Government funding, the second largest source, accounted for around 29% of the sector’s total funding in 2023-24. Nearly two thirds of adult hospices reported a financial deficit in 2023-24, with combined income from fundraising and government funding in decline.
Demand for hospice care is predicted to rise. The number of deaths per year in England has been increasing since 2012 say the NAO. In 2023, around 544,000 deaths were registered in England, projected to rise by around 21% to 658,000 by 2044. In 2024, 5% of people who died in England did so in a hospice inpatient unit, 28% died at home and 21% in a care home, while 42% died in hospital. With population demographics shifting and a rise in the proportion of older people in England, hospices and palliative care will come under even greater pressure.
The report says the Department of Health and Social Care (DHSE) and NHS England (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 of the way funding is provided; limited financial and activity data are available. 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.
According to the NAO, overall expenditure in the sector was £78 million more than the income generated forcing some hospices to reduce services.
The NAO recommend standardising the commissioning and funding of palliative and end-of-life care from hospices across all ICBs. The issue is one of ‘national importance’ concludes the report, particularly in the context of the current assisted dying debate and the sector’s role if it becomes legalised. Commenting on the report, Gareth Davies, head of the NAO, said
“Independent hospices play a key role in providing palliative and end-of-life care and provide choice for people at the end of their lives.
“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.”
