Source · Select Committees · Public Accounts Committee
Recommendation 5
5
The Department and NHS England are not responding to the growing financial crisis in the...
Conclusion
The Department and NHS England are not responding to the growing financial crisis in the adult hospice sector with the seriousness and urgency needed. The independent hospice sector is facing a serious financial situation that is already affecting patient care. Demand for hospice care is rising, but most hospices are reporting growing deficits, while several have announced cuts to services within the coming months if additional funding is not found. The Department recently provided funding of £125 million to hospices, but this was non-recurrent capital funding that does not directly fund service delivery or solve the continuing financial problems facing the sector. NHS England expects ICBs to undertake quality impact assessments if a hospice signals reductions in service that the NHS could not cope with. We welcome that, following the session, NHS England wrote to all ICBs requesting immediate, up-to-date assessments of the financial stability of hospices within their footprints and action to mitigate risks. The Modern Service Framework is expected to contain the details and plans for how NHS England will improve how ICBs commission and pay for services from hospices. However, with the framework not set to be completed until Autumn 2026, and then time needed to implement it, including the development of new payment mechanisms, we are concerned that the pace of change does not match the urgency of the situation. recommendation NHS England should work with ICBs to: • establish which hospices are forecasting imminent service reductions and confirm that for each of these, the ICB has undertaken a quality impact assessment; and • develop an individual plan for each such hospice, setting out how the ICB will support the hospice to maintain its services, or how the ICB will otherwise compensate for the service reductions. 5
Government Response
Response Pending
HM Government
Response Pending
The government agrees with the Committee’s recommendation: stability of hospices in their footprint, and the steps being taken to mitigate risks. ICBs are already expected to understand current and projected utilisation, costs, and risks across their commissioned palliative care and end-of-life care provision, as set out in the Strategic Commissioning Framework and Medium‑Term Planning Framework Through the ICB returns, there was a clear commitment across ICBs to working with their hospice providers to address any existing or potential impact on patients. This includes a combination of financial, operational and governance actions to prevent service closures, including tighter oversight through monthly risk meetings and formal risk register reporting, direct executive engagement with hospice leaders, deployment of emergency cashflow support and winter uplifts, and work to rebase statutory funding. ICBs are also strengthening provider collaboration through hospice alliances and tightening requirements for impact assessments before changes proceed. The government disagrees with the Committee’s recommendation: It is not for the government to make individual plans for each independent hospice. The government and NHS England will consider contracting and commissioning arrangements, including that of independent hospices, as part of our MSF. By supporting ICBs to commission strategically, we can move away from grant and block contract models. In the long term, this will aid sustainability and help hospices’ ability to plan ahead.