In hospices end-of-life patients are dying without palliative care, in avoidable pain and without dignity, because a funding crisis is forcing cuts in services and staff, sector leaders have claimed.
Birmingham Hospice has been forced to reduce its number of inpatient beds by a third and cut staff by 14% to cope with a £2.4mn deficit this year. The charity said the decision was down to a lack of government funding rather than its local fundraising efforts.
Hospices underfunded, undervalued and under pressure
According to umbrella body Hospice UK, hospices, which care for about 300,000 people a year, are “underfunded, undervalued and under more pressure than ever”.
Simon Fuller, CEO of Birmingham Hospice, and the CEOs of Marie Curie, National Bereavement Alliance, Sue Ryder, and Together for Short Lives, wrote to the leaders of political parties before the election, warning that too many people are dying in avoidable pain, with their families “left stressed, exhausted and traumatised”.
Birmingham Hospice was formed in 2021 from the merger of Birmingham St Mary’s Hospice in Selly Park and John Taylor Hospice in Erdington. Fuller said: “Reducing hospice services is bad for the people of Birmingham, the health care system, and those who will be affected by the proposed redundancies.”
He said there was a growing need for palliative and end-of-life care and the NHS is unable to meet the huge demands on its beds, and he called for “a sensible discussion on future of hospice care”.
Most hospices in deficit
Hospice UK surveyed 101 members and 96% reported they were budgeting for a deficit in the 2023-24 financial year, largely due to rising staff and energy costs. Energy bills for the sector are set to increase by £29mn over the next 12 months, with 86% of hospices set to come to the end of a fixed price deal by the end of the year.
Around two-thirds of adult hospice income and four-fifths of children’s hospice income is raised through fundraising. The rest comes from statutory funding.
According to Hospice UK, hospices faced a collective estimated deficit of £77mn in the financial year 2023-24. Staff costs jumped by 11%, equalling approximately £130mn in additional spending over the full year.
Hospices recruit from the same pool of staff, meaning they aim to match NHS pay and conditions to attract and retain skilled staff.
Adult hospices only receive on average around one third of their funding from the state, and children’s hospices only receive around one fifth.
Urgent call for reform
In their letter to political leaders, the CEOs estimated that the number of people needing palliative care would increase by 32,000 between 2024 and 2029 and Marie Curie CEO Matthew Reed says: “Dying people simply cannot wait, the next government must prioritise fully funding end-of-life care. Too many people are dying in avoidable pain, frightened and without the dignity they deserve. Families are left stressed, exhausted and traumatised.”
The letter urged party leaders to make the “reforms necessary to ensure that everyone received the best possible care and support at the end of life and through bereavement”.
Toby Porter, chief executive of Hospice UK, warned that the “next few years are critical for end-of-life care. We know that many people do not get the palliative care they need at the end of their lives, and we know that our ageing population means demand for care will continue to grow over the next decades.”
Heidi Travis, chief executive of Sue Ryder, said: “The demand for specialist palliative care services is expected to rise by 55% over the next decade. The constant uncertainty of funding will continue to be a threat to service provision until a sustainable solution is reached.”
Unfair funding model
Porter, of Hospice UK, said the current model of state funding was “arbitrary, inconsistent and unfair”.
Funding for hospices varies hugely, both between different regions, and often between different hospices delivering similar services in the same region.
“There’s no excuse. This situation can’t go on. There are solutions,” he said, citing better integration of hospices into local planning, fairer, multi-year contracts with local health boards based on activity and complexity, accompanied by commitments to automatically uplift contract values with inflation.
Ultimately, Porter added, central government must provide funding for palliative care and set minimum national standards of services.
Data collected by Hospice UK showed that there is not a single part of the country where government funding of local hospice services has not fallen in real terms in the last two years.
The state funding hospices receive is primarily distributed through regional Integrated Care Boards (ICBs) who have a statutory requirement to provide funding for palliative and end-of-life care appropriate to the level of need in their area.
While campaigners say that ICBs should provide ‘uplifts’ in contracts with hospices to reflect growing costs, they recognise that ICBs themselves ultimately rely on central government for the funds they have available.
MPs back reform
A report by the All Party Parliamentary Group (APPG) for Hospice and End of Life Care found that despite a 2002 law, the way hospice services were commissioned was not fit for purpose, with the result that hospice services were at risk.
The APPG called for a national plan to ensure the right funding flows to hospices. This should include measures to support ICBs with their commissioning decisions to secure current and future hospice funding.
MPs also said that ICBs should commit to fully delivering the statutory requirement set out in the Health and Care Act 2022. This should include placing hospices on multi-year contracts, paying the full cost of commissioned clinical services, and offering hospices the same annual contract value increases as NHS services.
Despite the legal requirement for ICBs to commission palliative and end-of-life care in the 2022 Health and Care Act, the APPG found that the funding hospices receive from ICBs varies significantly across the country in a ‘postcode lottery’ effect.
ICB adult hospice spending per head of population ranged from £10.33 to just 23 pence, according to research from Hospice UK.
The funding crisis hitting hospices joins a stack of other issues weighing down the in-trays of new ministers.
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