Fragile outlook on statutory funding for hospices in England
Statutory funding for adult and children’s hospices in England is fragile, unfair and unsustainable according to findings released today by national charities, Hospice UK and Together for Short Lives. More than two thirds of the hospices surveyed report that their statutory funding was frozen or slashed in 2014/15 - largely because of financial restrictions on NHS commissioners or stand still budgets.
Hospice UK and Together for Short Lives are calling on the Government to set out how it will bring about fair and sustainable statutory funding for hospice and palliative care.
Charitable hospices in England care for around 360,000 people each year - 120,000 patients and 240,000 family members - providing 26 million hours of care and potentially saving the NHS and social care millions of pounds every year. Yet funding for hospices from clinical commissioning groups (CCGs) and local authorities in England remains patchy and inconsistent.
There are early signs that the lack of fair and sustainable funding is already having an adverse effect on hospice services. This could lead to more pressure on already overstretched NHS services if hospices are forced to reduce the level of care they provide.
- The survey of 117 hospices in England shows that nearly a fifth of hospices surveyed (17%) - both children’s and adult hospices - had their funding reduced.
- For more than half of hospices surveyed (52%) funding has remained static. For many hospices this comes after several years of freezes in statutory funding.
- Some CCGs have increased funding, although this has been predominantly to develop new services rather than to increase funding for core services.
- More than eight in ten hospices surveyed (85 per cent) do not think their hospice is being funded fairly and sustainably by the NHS.
- CCG funding for adult hospices varies widely; across England, CCGs make contributions to hospice care costs which range from less than 1% to more than 50%.
- For children’s hospices, CCG funding contributes an average of just 10% of their care costs - compared to an average of around 30% for adult hospices.
- Nearly nine in ten children’s hospices surveyed (89%) said they could be forced to reduce their services if the annual NHS England grant to children’s hospices was not available.
- In spite of providing a range of social care services, less than a quarter (23%) of hospices surveyed reported receiving funding from local authorities to fund social care services.
- Almost three quarters (74%) of hospices in England surveyed expect their funding to be either frozen or cut again during this financial year (59% are expecting a funding freeze and 15% a cut).
- As a result of dwindling statutory funding levels a number of hospices are subsidising the shortfall through their reserves, freezing staff recruitment or putting service development on hold.
- Some hospices have warned they are likely to have to review the services they offer and may not be able to continue to provide the same level of care in the near future.
Jonathan Ellis, Director of Policy and Advocacy, at Hospice UK, said:
“NHS funding for hospice care is continuing to be squeezed, yet demand for hospice care continues to rise and will grow even more in the future, due to the UK’s ageing population.
“CCGs should be investing in hospice care which can help the NHS to cope with increasing demand, such as reducing the number of people who are in hospital at the end of life, with no need to be there. Freezing or cutting funding is both short-sighted and potentially damaging.
“In addition, NHS funding for hospice care is still very hit and miss, with sweeping variations across the country.
“Hospices are effectively in limbo until a new funding system for palliative care is implemented. As NHS funding comes under increasing pressure, we need a fairer, more sustainable system in place and we need this introduced soon. Failure by the NHS to act will be storing up huge problems for how our society supports terminally ill and dying people in the future.”
James Cooper, Interim Head of Public Affairs at Together for Short Lives, said:
“Children’s hospice services provide holistic care which can enhance quality of life for children with life-limiting conditions and their families - and can reduce unplanned hospital admissions. Despite pockets of good commissioning, on the whole CCGs and local authorities are still not funding children’s hospices in a way which reflects the vital role they play.
“A new palliative care funding system could help to address this. As a priority, however, the government must set out how those elements of children’s palliative care currently outside the scope of the new system - including short breaks and bereavement care - should be funded by the state.
“NHS England must also continue its annual grant to children’s hospices until a new system brings about fair and sustainable funding for children’s palliative care. Without it, children’s hospice services may have to scale back their life–line services which families rely on - which could put more pressure on the NHS.”
There is emerging evidence that investment in hospices is very cost-effective in terms of reducing spend on hospital care in the last year of life, supporting more deaths at home and in care homes and at the same time, improving patient experience and choice.
You can download and read the survey report here.