Recommendations & Conclusions
17 items
3
Recommendation
73rd Report - Financial sustainability …
Accepted
NHS England has been too slow to enforce a commissioning approach for the provision of palliative care that focuses on the quality of outcomes for patients. ICBs continue to fund hospices largely through grants and block contracts, despite the NHS widely using payment schemes that align payments with incentives and …
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NHS England has been too slow to enforce a commissioning approach for the provision of palliative care that focuses on the quality of outcomes for patients. ICBs continue to fund hospices largely through grants and block contracts, despite the NHS widely using payment schemes that align payments with incentives and fund on the basis of activity and outcomes. The Department and NHS England cannot show whether the quality of life for patients receiving palliative care is improving, whether they receive care in the right setting, or that unnecessary hospital stays are being avoided. New tariffs, payment mechanisms and incentives are being developed to align funding with need, and the Strategic Commissioning Development Programme for ICBs is planned to launch in April 2026 alongside guidance through a strategic framework. However, there is concern in the sector that multi-year commissioning models are not being implemented quickly enough given the financial pressures hospices are facing. NHS England is relying on ICBs to address financial problems and drive change in their areas, but NHS England must itself lead the adoption of improved commissioning approaches given the problems are system-wide and very variable, and particularly while ICBs are undergoing significant restructuring. recommendation NHS England should set out its plan for supporting all ICBs to adopt a consistent commissioning approach for the provision of palliative and end-of-life care that focuses on high-quality care outcomes for patients.
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Government response AI summary
NHS England published statutory guidance for palliative care and end-of-life care, as well as service specifications. NHS England will work with some ICBs to develop new payment models to support neighbourhood services, including for the high- priority cohorts, including those at end of life. The …
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HM Treasury
4
Recommendation
73rd Report - Financial sustainability …
Accepted
Too many patients spend their last days receiving palliative care in acute hospitals, which does not always achieve the best outcomes for patients nor represent value for money. Patients are frequently receiving palliative care and reaching the end of their lives in settings they would prefer not to be—in hospitals …
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Too many patients spend their last days receiving palliative care in acute hospitals, which does not always achieve the best outcomes for patients nor represent value for money. Patients are frequently receiving palliative care and reaching the end of their lives in settings they would prefer not to be—in hospitals rather than at home or in a hospice—and which are more expensive. Around one in four adults cared for in acute 4 hospitals are in the last year of their life, accounting for about 10 million bed days each year, when many could be in other settings that are better suited to supporting their needs. Hospices annually support around 20,000 people to die in community settings rather than in hospital, saving the NHS approximately 1.5 million bed days and around £800 million. NHS England use a dashboard to track patients at the end of their lives across all ICBs, which highlights the significant number of people who need not be in hospitals and would rather be at home. recommendation NHS England should explain, in detail, how it will move more palliative and end-of-life care out of acute settings and into the community, and the savings it expects this will deliver.
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Government response AI summary
The government is developing a Palliative Care and End‑of‑Life Care MSF which will support the shift to strategic commissioning based on integrated needs assessments and will outline evidenced based interventions. It will also build on the recently published Neighbourhood Health Framework, which sets clear expectations …
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HM Treasury
1
Conclusion
73rd Report - Financial sustainability …
Accepted
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (the Department) and NHS England on the provision of palliative and end-of-life care, and the funding of England’s independent adult hospices.1 We also took evidence from Baroness …
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On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (the Department) and NHS England on the provision of palliative and end-of-life care, and the funding of England’s independent adult hospices.1 We also took evidence from Baroness Ilora Finlay of Llandaff, Professor Fliss Murtagh and Hospice UK.
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Government response AI summary
The government agrees with the committee’s recommendation: service specifications for adults and children and young people, outlining expectations of what palliative care and end-of-life care services are commissioned.
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HM Treasury
8
Recommendation
73rd Report - Financial sustainability …
Accepted
The NAO reported that the mix of funding mechanisms varies between ICB areas, largely comprising a mix of historic grants and block contracts with few examples of activity-based contracts used in a strategic commissioning approach.11 Progress in moving towards strategic commissioning has been slow. NHS England explained that it is …
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The NAO reported that the mix of funding mechanisms varies between ICB areas, largely comprising a mix of historic grants and block contracts with few examples of activity-based contracts used in a strategic commissioning approach.11 Progress in moving towards strategic commissioning has been slow. NHS England explained that it is a long, complicated process of unravelling how the money is currently connected to services.12 The continued reliance on the current funding arrangements has meant there is little clarity over what ICBs are paying for or the volume of these services.13 Hospice UK highlighted the current financial pressures on the independent hospice sector and informed us that hospices raise and spend £1.2 billion a year on care, but only receive approximately £400 million in statutory funding.14
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Government response AI summary
The government agrees with the committee's recommendation to address slow progress in strategic commissioning and reform funding mechanisms, with an implementation target of Autumn 2026. It plans to use the Palliative Care and End-of-Life Care Modern Service Framework (MSF) to strengthen commissioning and improve sustainability …
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HM Treasury
9
Recommendation
73rd Report - Financial sustainability …
Accepted
NHS England told us that although it does collect patient-level activity data, it needs to start collecting more. It currently does not collect activity data from all hospices and therefore cannot determine how much care ICBs are buying from hospices, the quality of the services being delivered, outcomes for patients, …
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NHS England told us that although it does collect patient-level activity data, it needs to start collecting more. It currently does not collect activity data from all hospices and therefore cannot determine how much care ICBs are buying from hospices, the quality of the services being delivered, outcomes for patients, or how hospice provision could be changing over time.15 Hospice UK pointed out an over-reliance on charitable giving to fund hospice services that is ultimately inequitable and unsustainable.16 7 Professor Fliss Murtagh (AHE0020) 8 Professor Fliss Murtagh (AHE0020) 9 C&AG’s report, para 2.4 10 Qq 56-57 11 C&AG’s report, para 1.14 12 Qq 42 and 80 13 Qq 20 and 39-42 14 Q 9 15 Qq 40-42 16 Q 18 10 The Modern Service Framework
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Government response AI summary
The government accepts the recommendation to improve data collection and address the over-reliance on charitable funding for hospices. It plans to achieve this through the Palliative Care and End-of-Life Care Modern Service Framework (MSF), slated for Autumn 2026, and the Strategic Commissioning Framework, which will …
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HM Treasury
10
Conclusion
73rd Report - Financial sustainability …
Accepted
There has not been a renewal of the government’s approach to delivering and improving palliative and end-of-life care in England since the first national strategy was published in 2008. The Health and Care Act 2022 introduced a legal duty for ICBs to commission palliative and end-of-life care services that meet …
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There has not been a renewal of the government’s approach to delivering and improving palliative and end-of-life care in England since the first national strategy was published in 2008. The Health and Care Act 2022 introduced a legal duty for ICBs to commission palliative and end-of-life care services that meet the needs of their local populations. However, we heard from the hospice sector that this has yet to result in universal access to quality services.17
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Government response AI summary
The government agrees with the committee's observation and is developing a Palliative Care and End-of-Life Care Modern Service Framework (MSF) for monitoring strategic commissioning. NHS England has already published guidance and frameworks, and will work with some ICBs to develop new payment models by Autumn …
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HM Treasury
11
Conclusion
73rd Report - Financial sustainability …
Accepted
The terms and conditions in the independent adult hospice sector have diverged from those in the NHS, with clinicians in hospices often earning less than their NHS counterparts.18 We heard from Hospice UK and NHS England how hospice provision is central to government’s objectives of providing more care in the …
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The terms and conditions in the independent adult hospice sector have diverged from those in the NHS, with clinicians in hospices often earning less than their NHS counterparts.18 We heard from Hospice UK and NHS England how hospice provision is central to government’s objectives of providing more care in the community, reducing hospital utilisation and aligning with patient preferences.19 However, sector representatives wrote to us to say that system-level governance and national oversight arrangements have not evolved to reflect this role.20
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Government response AI summary
The government agrees with the committee's finding, stating that ICBs have a duty to commission palliative care, supported by statutory guidance and NHS England's new strategic commissioning framework. This framework, with a target implementation date of Autumn 2026, aims to address governance issues in hospice …
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HM Treasury
15
Recommendation
73rd Report - Financial sustainability …
Accepted
ICBs currently fund hospices largely through grants and block contracts, which do not provide clarity over what is being purchased.28 The Department and NHS England acknowledged that there must be a move away from funding hospices in this way towards a strategic commissioning approach. However, they emphasised that transitioning to …
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ICBs currently fund hospices largely through grants and block contracts, which do not provide clarity over what is being purchased.28 The Department and NHS England acknowledged that there must be a move away from funding hospices in this way towards a strategic commissioning approach. However, they emphasised that transitioning to activity or outcome-based commissioning is a complicated process that would require a period to build the systems and mechanisms to ensure long-term sustainability and avoidance of the current position in the future.29
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Government response AI summary
The government accepts the recommendation to move away from grants and block contracts towards a strategic commissioning approach for hospices. It plans to address this through the Palliative Care and End-of-Life Care Modern Service Framework (MSF), due for publication in Autumn 2026, which aims to …
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HM Treasury
16
Conclusion
73rd Report - Financial sustainability …
Accepted
NHS England told us that ICBs are required to understand the needs of their populations and their projections of future demand.30 NHS England acknowledged that it must take the lead on establishing a single commissioning approach for the provision of palliative care. To support ICBs to become better strategic commissioners, …
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NHS England told us that ICBs are required to understand the needs of their populations and their projections of future demand.30 NHS England acknowledged that it must take the lead on establishing a single commissioning approach for the provision of palliative care. To support ICBs to become better strategic commissioners, NHS England told us of a strategic commissioning development and improvement programme for ICBs that is being launched in April this year. NHS England assured us that despite ICBs reducing in size, the programme will support them to increase their capacity to understand their population data and improve outcomes for their populations.31 25 Qq 13 and 43 26 Qq 45, 76 and 78; Letter from Sue Ryder, 16 January 2026 27 Q 13 28 C&AG’s report, paras 18–19 29 Qq 32, 34-35, 42-43 and 78 30 Qq 33-34 and 57 31 Qq 34-36 12
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Government response AI summary
The government agrees with the committee's findings, detailing existing and planned initiatives by NHS England to support ICBs in strategic commissioning. These include a Strategic Commissioning Framework, statutory guidance, and a forthcoming Palliative Care and End-of-Life Care MSF by Autumn 2026.
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HM Treasury
17
Recommendation
73rd Report - Financial sustainability …
Accepted
Professor Murtagh stressed that ICBs need to commission on the basis of activity and outcomes. Professor Murtagh explained that this approach is already used elsewhere in the NHS through a blended payment model that aligns payments with incentives, and questioned why it is not being used to commission care from …
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Professor Murtagh stressed that ICBs need to commission on the basis of activity and outcomes. Professor Murtagh explained that this approach is already used elsewhere in the NHS through a blended payment model that aligns payments with incentives, and questioned why it is not being used to commission care from hospices.32 She drew attention to the loss of mechanisms that captured and reported on hospices’ activity.33 NHS England acknowledged that currently data is very poor, and told us that, over time, ICBs will have more data upon which to base their commissioning decisions.34
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Government response AI summary
The government accepts the recommendation for ICBs to commission palliative and end-of-life care based on activity and outcomes. It outlines multiple existing frameworks and guidance, commits NHS England to developing new payment models with ICBs, and plans for the Palliative Care and End-of-Life Care MSF …
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HM Treasury
18
Recommendation
73rd Report - Financial sustainability …
Accepted
We are concerned that adult hospices do not benefit from multi-year funding settlements, as children’s hospices do. NHS England agreed that this was an issue, and that it is working towards providing hospices with better certainty over funding over a two- or three-year period, something it has not done for …
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We are concerned that adult hospices do not benefit from multi-year funding settlements, as children’s hospices do. NHS England agreed that this was an issue, and that it is working towards providing hospices with better certainty over funding over a two- or three-year period, something it has not done for several years. But it cautioned that it would not be able to provide guaranteed levels of funding over three to five-year periods. The Department told us that its intention was that the Modern Service Framework would address multi-year funding, but cautioned that it was subject to ministerial approval and would not be introduced in the next financial year.35 32 Q 15 33 Q 20 34 Q 32 35 Qq 64-68 13 2 Delivery of palliative and end-of-life care services Where palliative care is delivered
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Government response AI summary
The government accepts the recommendation, agreeing that multi-year funding is an issue. It plans to address this through the Palliative Care and End-of-Life Care Modern Service Framework (MSF), slated for publication in Autumn 2026, which aims to strengthen commissioning and move away from current funding …
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HM Treasury
19
Conclusion
73rd Report - Financial sustainability …
Accepted
Professor Murtagh told us that for a long time it has been known that around one in four adults who need palliative care do not get it, and that recent research suggests that the proportion may now be even higher.36 She went on to describe how a third of people …
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Professor Murtagh told us that for a long time it has been known that around one in four adults who need palliative care do not get it, and that recent research suggests that the proportion may now be even higher.36 She went on to describe how 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. Many patients are not benefitting from acute care and might rather receive palliative care.37 The Department and NHS England recognised that some people are receiving care in more expensive settings than they need to be, particularly in acute hospitals.38
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Government response AI summary
The government accepts the implied recommendation to improve access to palliative care and shift care out of acute hospital settings. It plans to achieve this through the Palliative Care and End-of-Life Care MSF by Autumn 2026, which will include metrics to reduce avoidable hospital admissions …
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HM Treasury
20
Conclusion
73rd Report - Financial sustainability …
Accepted
The Department and NHS England agreed that there are gaps in provision of palliative and end of life care and that it must meet demand where it is needed.39 They also acknowledged the importance of moving care away from costly acute settings into the community, citing a dashboard that they …
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The Department and NHS England agreed that there are gaps in provision of palliative and end of life care and that it must meet demand where it is needed.39 They also acknowledged the importance of moving care away from costly acute settings into the community, citing a dashboard that they use to track patients who are receiving care but may not need to be in hospital.40 Professor Murtagh told us that around 500,000 people die in England each year, and of these around 42% do so in hospitals, where many people do not want or need to be and which is typically more expensive than other settings. Some 28% die at home, which is where most people would prefer to be, while 21% die in care homes and 5% in hospices.41 She also highlighted the disproportionate flow of end-of-life funding that goes to the acute sector. On average, £22,000 is spent per person in the last year of their life, with 78% going to the acute hospital sector, approximately 5% to the hospice sector, and 4% to other partners in formal healthcare, including the ambulance service and district and community nursing.42 36 Q 6 37 Qq 12 and 24 38 Q 30 39 Qq 29, 38 and 80 40 Qq 34, 39 and 49 41 Professor Fliss Murtagh (AHE0020) 42 Q 5 14
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Government response AI summary
The government accepts the implied recommendation to address gaps in palliative and end-of-life care provision and to rebalance funding away from the acute sector. It plans to achieve this through the Palliative Care and End-of-Life Care MSF by Autumn 2026, which will include metrics to …
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HM Treasury
21
Recommendation
73rd Report - Financial sustainability …
Accepted
Professor Murtagh stressed the importance of having earlier conversations with patients and their families about possible deterioration and approaching death, to ascertain their wishes. Without such conversations, patients may continue to have high-cost treatment they may not benefit from.43 NHS England agreed, and acknowledged that it had more to do …
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Professor Murtagh stressed the importance of having earlier conversations with patients and their families about possible deterioration and approaching death, to ascertain their wishes. Without such conversations, patients may continue to have high-cost treatment they may not benefit from.43 NHS England agreed, and acknowledged that it had more to do to ensure all patients in the last year of life have advanced care plans to support the right care being delivered in the patients’ preferred settings.44 Growing financial crisis in the adult hospice sector
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Government response AI summary
The government agrees with the recommendation, setting an Autumn 2026 target implementation date, and is developing a Palliative Care and End-of-Life Care MSF and building on existing frameworks to support earlier conversations and advanced care plans for patients.
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HM Treasury
22
Conclusion
73rd Report - Financial sustainability …
Accepted
Some hospices have recently reduced the volume or range of services they provide and others are planning to do so, at a time when demand for palliative and end-of-life care is rising.45 Hospice UK told us that hospices are facing a cliff edge from April, and if no new funding …
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Some hospices have recently reduced the volume or range of services they provide and others are planning to do so, at a time when demand for palliative and end-of-life care is rising.45 Hospice UK told us that hospices are facing a cliff edge from April, and if no new funding is injected into the sector before the new financial year, hospices would be forced to reduce services further.46 It told us of hospices that have already announced staff redundancies.47 We received submissions from several hospices telling us that they were operating deficits, including annual deficits of £780,000 for Mary Ann Evans Hospice and £1.1 million for Rotherham Hospice. Marie Curie told us it is currently running a structural operating deficit.48 The Committee referred to three hospices—Prospect hospice in Swindon, Birmingham hospice and St Giles hospice in Lichfield—which have announced redundancies or have closed in-patient beds.49
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Government response AI summary
The government accepts the implied recommendation to address financial pressures leading to service reductions in hospices. It details existing actions, including NHS England's request for ICB assessments on hospice financial stability, and ICBs' reported commitments to prevent service closures through various financial, operational, and governance …
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HM Treasury
23
Conclusion
73rd Report - Financial sustainability …
Accepted
NHS England emphasised that it is aware that every hospice provider is worried about financial sustainability, but that it is unaware of any hospices facing immediate closure.50 It told us it expects ICBs to undertake quality impact assessments if a hospice signals reductions in service that would have a disproportionate …
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NHS England emphasised that it is aware that every hospice provider is worried about financial sustainability, but that it is unaware of any hospices facing immediate closure.50 It told us it expects ICBs to undertake quality impact assessments if a hospice signals reductions in service that would have a disproportionate impact or an impact the NHS could not cope with.51 Following our evidence session in January, NHS England wrote to tell us that it had written to all ICBs requesting immediate, up-to-date assessments of the financial stability of hospices within their footprints and the action being taken to mitigate risks.52 The Department highlighted the 43 Qq 5, 12, 16 and 27 44 Q 34 45 C&AG’s report, paras 11 and 24 46 Q 13 47 Hospice UK (AHE0017) 48 Rotherham Hospice (AHE0002); Mary Ann Evans Hospice (AHE0005); Marie Curie (AHE0018) 49 Q 75 50 Qq 71-72 51 Qq 52, 57 and 75 52 Q 75; Letter from NHS England, 16 January 2026 15 £125 million capital funding that had recently been provided to the sector, demonstrating, it said, ministerial commitment to independent hospices. However, Hospice UK told us that while the capital funding is welcome it is one-off funding that will not address the shortfalls in funding for service delivery.53
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Government response AI summary
The government accepts the implied recommendation regarding hospice financial stability. It outlines existing actions, such as NHS England requesting financial stability assessments from ICBs and ICBs' commitments to prevent service closures through various financial, operational, and governance actions.
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HM Treasury
26
Conclusion
73rd Report - Financial sustainability …
Accepted
Baroness Finlay emphasised the role that hospices have as an important source of expertise in palliative and end-of-life care, available to professionals in the NHS such as district nurses and care assistants.58 NHS England told us how hospices support training NHS professionals in palliative and end-of-life care skills and how …
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Baroness Finlay emphasised the role that hospices have as an important source of expertise in palliative and end-of-life care, available to professionals in the NHS such as district nurses and care assistants.58 NHS England told us how hospices support training NHS professionals in palliative and end-of-life care skills and how to work in community settings.59 In lots of places, hospices are the providers of 24/7 palliative care advice and support lines, offering telephone support for patients and their families that can help avoid people being taken to A&E unnecessarily.60 53 Qq 9 and 50-51 54 Q 74 55 Letter from NHS England, 16 January 2026 56 Qq 30-31, 43-44 and 66 57 C&AG’s report, para 5 58 Q 12 59 Qq 3 and 53 60 Qq 21, 35 and 69 16
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Government response AI summary
Despite stating disagreement with the conclusion, the government's response outlines strong support for hospices, including close collaboration on the Modern Service Framework (MSF) and substantial funding. It is providing £125 million in capital funding and approximately £80 million in revenue funding for children and young …
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HM Treasury