Source · Select Committees · Public Accounts Committee
Recommendation 3
3
NHS England has been too slow to enforce a commissioning approach for the provision of...
Recommendation
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.
Government Response
Response Pending
HM Government
Response Pending
The government agrees with the Committee’s recommendation. ICBs to respond effectively to current and future needs of their population, in line with the wider expectation of the Model ICB Blueprint. More specifically, NHS England has also published statutory guidance for palliative care and end-of-life care, as well as service specifications (adults and children and young people). The Medium-Term Planning Framework, states that ICBs and relevant NHS providers should ensure an understanding of current and projected total service utilisation and costs, including for those with palliative care and end-of-life care needs and create an overall plan to more effectively manage patient needs effectively manage and significantly reduce avoidable unplanned admissions. Guidance on how ICBs move towards effective population health delivery models and commission providers around the needs of defined populations was published alongside the Neighbourhood Health Framework on 17 March 2026. 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 government is developing a Palliative Care and End-of-Life Care MSF, through which we will closely monitor the shift towards strategic commissioning of palliative care and end-of-life care services across all ICBs.