Recommendations & Conclusions
11 items
2
Recommendation
73rd Report - Financial sustainability …
Rejected
Only now are the Department and NHS England developing a Modern Service Framework for palliative and end-of-life care, but so far the details are unclear. There has not been a new national strategy for improving palliative and end-of-life care in England since 2008. The Health and Care Act 2022 set …
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Only now are the Department and NHS England developing a Modern Service Framework for palliative and end-of-life care, but so far the details are unclear. There has not been a new national strategy for improving palliative and end-of-life care in England since 2008. The Health and Care Act 2022 set out a legal duty for ICBs to commission palliative care services that meet the needs of the local population, but this has not yet delivered equal access to quality services. Hospices are central to achieving government’s objectives of providing more care in the community and reducing hospital use, but national oversight of the palliative and end-of-life care system has not kept pace with this policy shift. Hospices have diverged 3 from the NHS in some ways, for example, clinicians in hospices are often paid less than their NHS counterparts. The Modern Service Framework that the Department and NHS England are developing aims to bring together disparate elements of the system, including facilitating ICBs to improve their commissioning of care services from hospices, but its details at present are vague, and its delivery will require clear plans and sustained investment to fix the long-standing problems within the sector. recommendation DHSC and NHS England should work with and take on board the views of the hospice sector to develop and publish a fully costed delivery plan alongside the framework.
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Government response AI summary
The government disagrees with developing and publishing a fully costed delivery plan alongside the (modern service) framework but that they should work with and take on board the views of the hospice sector as part of the development of the (modern service) framework.
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HM Treasury
6
Recommendation
73rd Report - Financial sustainability …
Rejected
The NHS is at risk of losing the huge value it gains from independent hospices beyond the provision of statutory palliative and end-of-life care. Independent hospices provide enhanced care compared with the NHS, such as complementary therapies, funded from charitable donations. As well as patient care, they provide expert advice …
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The NHS is at risk of losing the huge value it gains from independent hospices beyond the provision of statutory palliative and end-of-life care. Independent hospices provide enhanced care compared with the NHS, such as complementary therapies, funded from charitable donations. As well as patient care, they provide expert advice and training on palliative and end-of-life care to the NHS. Their independence enables a degree of innovation in care delivery methods that the NHS cannot easily replicate, and they are leading the move to provide more palliative care in community settings. NHS England acknowledges that hospices are a key part of the delivery of neighbourhood care, for example through their provision of 24/7 palliative care advice lines that support communities and help reduce hospital admissions. Hospices are increasingly supporting wider community services, such as care homes and general practice. The financial situation of the hospice sector puts the Department and NHS England at risk of losing this value and having to dedicate resources to replace the lost expertise. recommendation The Department and NHS England should ensure the Modern Service Framework will thoroughly examine: • the full range of wider benefits that independent hospices provide and that the NHS gains from; and • how the Department will protect and support the provision of these benefits in the future.
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Government response AI summary
The government disagrees, but states that it is working closely with Hospice UK, Marie Curie, Sue Ryder and Together for Short Lives to ensure the views of hospices are gathered and considered at every stage of the MSF development and will also consider high-potential innovation.
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HM Treasury
7
Recommendation
73rd Report - Financial sustainability …
Rejected
Hospice collaboratives have the potential to deliver efficiencies and further raise the quality of care, but their development is lacking central support from the Department and NHS England. Some hospices are working together to form collaboratives within ICB regions, offering opportunities for coordinated planning, shared functions, reduced costs through economies …
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Hospice collaboratives have the potential to deliver efficiencies and further raise the quality of care, but their development is lacking central support from the Department and NHS England. Some hospices are working together to form collaboratives within ICB regions, offering opportunities for coordinated planning, shared functions, reduced costs through economies of scale and shared management of financial risk. The NAO reported that seven collaboratives are well established across England, with five at an early stage of development. We received submissions from three collaboratives that described how working in partnership across a region reduced needless duplication, minimised unwarranted variation in care, enabled smarter workforce planning and presented a united voice to the ICB. Collaboratives can help ICBs to more readily assess their areas’ overall provision of palliative care and commission services more effectively. NHS England considers the collaborative model to be right for the hospice sector and key to improving care provision. 6 recommendation The Department and NHS England should set out what it can do to support hospices to develop existing collaborative operating models to derive as much financial benefit and service improvement as possible, and to implement collaboration in all areas where it is feasible. 7 1 National oversight and commissioning of palliative and end-of-life care services Introduction
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Government response AI summary
The government recognises that hospice collaboratives can play an important role but states it is not the place of the department or NHS England, to set out the working practices, or operating models, of independent organisations, such as hospices.
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HM Treasury
12
Recommendation
73rd Report - Financial sustainability …
Rejected
The Department and NHS England told us that data on patient-level activity from hospices, which ICBs need in their role as commissioners, is not strong or robust enough, because hospices are only obliged to report activity data when they are funded through a contract.21 Professor Murtagh described how activity across …
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The Department and NHS England told us that data on patient-level activity from hospices, which ICBs need in their role as commissioners, is not strong or robust enough, because hospices are only obliged to report activity data when they are funded through a contract.21 Professor Murtagh described how activity across the hospice sector is not understood well enough, and Hospice UK referenced the NAO report that showed the variability in reporting and catching activity data.22 NHS England informed us of their Faster Data Flows programme, but noted that rollout to independent hospices has only recently begun.23
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Government response AI summary
The government explicitly disagrees with the committee's recommendation regarding the lack of robust patient-level data from hospices. Its response focuses instead on guidance for ICBs on population health delivery models and the development of new payment models, without addressing the specific data collection or Faster …
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HM Treasury
13
Recommendation
73rd Report - Financial sustainability …
Rejected
The Department and NHS England told us about the ‘Modern Service Framework’ they are currently developing, which they intend will bring together disparate elements of the system and will set out what “good” commissioning for palliative and end-of-life care looks like.24 17 C&AG’s Report, para 3; Marie Curie (AHE0018) 18 …
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The Department and NHS England told us about the ‘Modern Service Framework’ they are currently developing, which they intend will bring together disparate elements of the system and will set out what “good” commissioning for palliative and end-of-life care looks like.24 17 C&AG’s Report, para 3; Marie Curie (AHE0018) 18 AHE0004 (AHE0004); Dr Becky Ogundele , Dr Sarah Longwell, Dr Emily Holdsworth, Dr Liam Gabb, Dr Alex Oyon , Dr Anna Grundy, Dr Iain Murphy, and Dr Alice Gray (AHE0006); Sue Ryder (AHE0015) 19 Qq 10, 34 and 69 20 Lancashire South Cumbria Hospices Together, Pendleside Hospice (AHE0008); Gianina Caballero (AHE0016) 21 Qq 39-42 22 Qq 19-20 23 Qq 7 and 40 24 Qq 31, 45 and 49 11 However, they were vague on detail of the contents of the framework, and we are concerned, as is the sector, that this may prove to be another ambition that is not delivered.25
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Government response AI summary
The government explicitly rejects the recommendation to publish a fully costed delivery plan alongside the Modern Service Framework (MSF). While it will include a delivery plan as part of the MSF, it does not commit to it being fully costed.
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HM Treasury
14
Conclusion
73rd Report - Financial sustainability …
Rejected
The Department and NHS England are aiming to launch the framework later this year in the autumn. However, we are concerned that it will still take time for ICBs to change their commissioning arrangements, a concern reiterated by Sue Ryder who wrote to use after the January session.26 The sector …
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The Department and NHS England are aiming to launch the framework later this year in the autumn. However, we are concerned that it will still take time for ICBs to change their commissioning arrangements, a concern reiterated by Sue Ryder who wrote to use after the January session.26 The sector representatives were supportive of the framework but highlighted that it would require investment to implement, and there appeared to be no new funding attached to it. They also told us that if there was no additional funding before the new financial year, some hospices will have reduced capacity and services by the time the framework launches.27 Commissioning palliative and end-of-life care
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Government response AI summary
The government disagrees with the committee's concerns, specifically rejecting the development and publication of a fully costed delivery plan alongside the Modern Service Framework (MSF). It states a delivery plan will be part of the MSF, focusing on effective and equitable use of existing resources …
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HM Treasury
24
Recommendation
73rd Report - Financial sustainability …
Rejected
NHS England agreed that the hospice sector is fundamentally in financial distress and that there is a need to move quickly to resolve and fix the problems. But it stressed the need to avoid perpetuating problems, such as supporting a provider delivering substandard care.54 NHS England wrote to us after …
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NHS England agreed that the hospice sector is fundamentally in financial distress and that there is a need to move quickly to resolve and fix the problems. But it stressed the need to avoid perpetuating problems, such as supporting a provider delivering substandard care.54 NHS England wrote to us after the session to reiterate that the development of the Modern Service Framework is their immediate action to address the fundamental issues in palliative and end-of-life care.55 However, we are concerned that only after the framework is published in autumn 2026 will new payment mechanisms be produced, taking more time to implement.56 Wider value of independent hospices
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Government response AI summary
The government explicitly disagrees with the committee's recommendation for faster action on new payment mechanisms, reiterating that these will be considered as part of the Modern Service Framework. They state it is not their role to make individual plans for independent hospices, but believe the …
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HM Treasury
25
Conclusion
73rd Report - Financial sustainability …
Rejected
The NAO report describes how independent hospices offer additional services that are typically outside the remit of the NHS, for example certain complementary therapies, funded from hospices’ charitable donations. Hospices offer support to the family, friends and carers of those receiving palliative and end-of-life care, for example through counselling and …
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The NAO report describes how independent hospices offer additional services that are typically outside the remit of the NHS, for example certain complementary therapies, funded from hospices’ charitable donations. Hospices offer support to the family, friends and carers of those receiving palliative and end-of-life care, for example through counselling and bereavement support. Many hospices provide training in palliative and end-of-life care to a broad range of healthcare professionals, including to the NHS, and some hospices undertake clinical research.57
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Government response AI summary
The government explicitly disagrees with the committee's observation regarding the additional services and broader contributions of independent hospices. However, the response details ongoing work with hospice charities, the development of the MSF to consider innovation and strategic commissioning, and substantial capital and revenue funding for …
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HM Treasury
27
Conclusion
73rd Report - Financial sustainability …
Rejected
The Department and NHS England stressed how hospices’ positioning within communities supports the development of neighbourhood health services that the NHS 10-year plan is promoting. Hospices are increasingly supporting wider community services, such as care homes and general practice.61 Hospices are leading the move to providing more palliative care in …
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The Department and NHS England stressed how hospices’ positioning within communities supports the development of neighbourhood health services that the NHS 10-year plan is promoting. Hospices are increasingly supporting wider community services, such as care homes and general practice.61 Hospices are leading the move to providing more palliative care in the community and in the settings where people want it.62 We heard from Baroness Finlay and Hospice UK how hospices’ independence enables them to develop and innovate models of care delivery in ways the NHS cannot do so readily.63 Hospice Collaborations
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Government response AI summary
The government explicitly disagrees with the committee's observation. However, it states it is working with the independent hospice sector, considering high-potential innovation within the Palliative Care and End-of-Life Care Modern Service Framework (MSF), and providing significant capital and revenue funding to hospices.
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HM Treasury
28
Conclusion
73rd Report - Financial sustainability …
Rejected
Collaboratives are groups of independent hospices within an ICB region, including Marie Curie, Sue Ryder and children’s hospices where they are present, which work in partnership, developing a more coordinated approach to the provision of palliative and end-of-life care across a region. The NAO reported that there are currently seven …
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Collaboratives are groups of independent hospices within an ICB region, including Marie Curie, Sue Ryder and children’s hospices where they are present, which work in partnership, developing a more coordinated approach to the provision of palliative and end-of-life care across a region. The NAO reported that there are currently seven well-established collaboratives covering individual ICBs: three in the North West region, two in the North East and Yorkshire region and two in the South East region. There are another five collaboratives that have been established but are at an early stage of development, and six groups of hospices that are considering collaboratives.64
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Government response AI summary
The government rejects an implied recommendation to intervene in or direct the working practices of hospice collaboratives, stating it's not their role to set the operating models for independent organisations. However, it will consider how to support and spread good practice for these models through …
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HM Treasury
30
Recommendation
73rd Report - Financial sustainability …
Rejected
NHS England told us about the West Yorkshire collaborative, which it considers to be the most advanced and an example for how hospices in all ICB regions could work in partnership. NHS England pointed to the economies of scale and improved commissioning that the collaborative model enabled.66 Professor Murtagh told …
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NHS England told us about the West Yorkshire collaborative, which it considers to be the most advanced and an example for how hospices in all ICB regions could work in partnership. NHS England pointed to the economies of scale and improved commissioning that the collaborative model enabled.66 Professor Murtagh told us that the Department and NHS England should be including collaborative working within the Modern Service Framework.67 However, although NHS England told us that forming a collaborative was perhaps the most effective first stage for groups of hospices experiencing financial difficulties, it expects hospices to take this step themselves and it did not signal any intention to encourage or support the creation of collaboratives.68 66 Qq 45, 48 and 51 67 Q 17 68 Qq 48 and 51 18
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Government response AI summary
The government explicitly disagrees with the recommendation to encourage or support hospice collaboratives, stating it is not their role to dictate practices for independent organisations. However, they recognise the importance of collaboratives, are considering how to support existing models and spread good practice through the …
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HM Treasury