Growing Financial Crisis for Hospices Met with No Serious Government Response, PAC Warns

The government and NHS England are not responding to the growing financial crisis in the adult hospice sector with the seriousness and urgency the situation demands The Public Accounts Committee (PAC) has warned.

In a new report on the financial sustainability of adult hospices in England, PAC warns that some hospices have recently reduced the volume or range of the essential services they provide and others are planning to do so, at a time when demand for palliative and end-of-life care is rising.
The PAC’s inquiry heard that hospices are facing a funding cliff-edge from April, and that if no new funding is injected into the sector before the new financial year, hospices would be forced to reduce services further.

Some hospices have already announced staff redundancies, with the PAC’s written evidence from several hospices demonstrating significant financial deficits.

Marie Curie, one of two national chains in the sector, told the PAC that it is currently running a structural operating deficit. PAC members are warning that it is urgent that government address the withdrawal of services and cuts which are being made now ahead of April.

The report warns further of the wider dimension of how the financial situation for hospices risks depriving the NHS of the huge value they provide beyond statutory palliative and end-of-life care – expert advice and training, innovation in care, leadership in the move to provide more care in the community, and support for care homes and GPs.

Around a quarter of adults are still spending their last days receiving costly palliative care in hospital, where many would prefer not to be and the PAC’s inquiry heard that a third of people receiving acute care in hospital are in the last year of life, accounting for about 10 million bed days each year.

Expert witnesses further stressed the importance of having earlier conversations with patients and families about approaching death, to ascertain their wishes, without which people may continue to have costly treatment from which they may not benefit. The PAC’s report is seeking a detailed explanation from NHS England on how it will move more palliative and end-of-life care into the community.

The government’s current proposed solutions to the sector’s challenges relies on local health boards solving everything locally, despite the boards themselves currently being subject to greatly reduced staff numbers under the government’s wider reorganisation of the health system.

The details of the government’s new framework for hospices to improve how boards pay for services from hospices are unclear. The framework itself is not set to be completed until autumn of this year with further time needed to implement it, though several hospices have announced cuts in the coming months if additional funding cannot be found.

Government provided £125m in funding to hospices recently, but the PAC’s inquiry heard from the sector that while the capital funding is welcome it is one-off funding that will not address the shortfalls in funding for service delivery.

The PAC’s report notes that, amid this slow pace of reform, the sector is lacking a national-level intervention. Neither government nor NHSE has effective oversight of hospices. With much of the demand for care funded by charitable income, and as local boards do not routinely collect granular data from hospices, there is no clarity over what care public funding is paying for.

Sir Geoffrey Clifton-Brown, Chair of the Public Accounts Committee, said: “The mark of a civilised society is how it treats its elderly people, and the services provided by hospices in England could not be more important in that regard. All of us, whoever we are, deserve access to care and in an environment that gives us the best possible quality of life as we approach the end.

“The institutions whose job it is to help ease our final days deserve to have recognition of the central role they play in our health system. And yet government’s actions, despite all reassurances to the contrary, are communicating a certain blithe certainty that the sector’s challenges will be resolved at the local level.

“We acknowledge the government’s insistence that it lacks complacency, but the autumn timelines of the arrival of its current reforms risk ignoring the reality. A funding cliff-edge is approaching in only a month. Details of what these reforms might look like are thin on the ground, but regardless, by the time any help arrives, invaluable services may already have been cut.”