Around 360,000 terminally ill people and their families receive vital support from hospices each year. While hospices rely primarily on charitable funds for their work, statutory funding is an important source of income but worryingly this is dwindling.
A recent survey from Help the Hospices into NHS commissioning throughout England has revealed that an alarming 50 per cent of hospices have had their funding cut or frozen for 2014/2015. For some hospices there has been a pattern of reducing or static funding over several years.
These are tough economic times for statutory funding of healthcare. It would be unrealistic to expect NHS funding for hospice care, which has on average made up a third of funding (32 per cent) for adult hospices and 17 per cent for children's services, to be exempt from this. What did surprise us were the sharp variations in funding and in cuts for hospices both within and between geographical areas.
Reported funding cuts ranged from less than one per cent (0.9%) to as much as 20 per cent of a hospice's overall NHS funding. For instance, one hospice saw a £46,000 cut - a figure that would cover the daily cost of providing a bed on its inpatient unit for three months.
One positive point to note is that 83 per cent of hospices surveyed reported being engaged with their local Clinical Commissioning Groups (CCGs); however a third (32 per cent) of the hospices we heard from had not yet agreed funding levels with one or more of their NHS commissioners for 2014/2015. While it appears that the majority of hospices are managing to get to the commissioning table, the conversations that commissioners are willing to have can still lead to uncertainty around future funding.
In their local communities, hospices are recognised as providing essential services to terminally ill people, however we need to see their value more widely reflected in the actions of NHS commissioners. At a time of financial pressure on the NHS, local NHS bodies could find an invaluable ally in the hospice movement and its ability to provide excellent end of life care.
For this to become a reality we need to make sure that the structures and processes around securing NHS funding are appropriate and efficient, rather than needlessly bureaucratic. One hospice told us that it had 25 statutory funding arrangements with 15 different commissioning bodies - and a third of all hospices surveyed reported that they were working with four or more different commissioning bodies; often securing only small levels of funding as a result. The administration involved in agreeing such complex arrangements can be disproportionate, and divert time and energy away from care services.
One solution could be the use of co-commissioning agreements (an agreement that reflects the real relationship between the NHS and hospices as co-funders of care). While instances of these agreements are few, it is encouraging to see that eight hospices have entered in to co-commissioning agreements this year - an increase from five in 2013.
One in three of us will have experience of hospice services - either directly or through a loved one. How the NHS supports those charity services could vary enormously depending on where you live. We hope that the new funding system for palliative care, which the Government has promised to deliver, will address the 'lucky dip' system that hospices are currently faced with.
Local hospices are providing expert solutions to a national problem. While it is the generous support of local people that continues to provide the main source of funding for hospice care in the UK, fairer and sustainable funding from the NHS would allow the hospice movement to better support the health and social care system to tackle the looming care crisis ahead - supporting the needs of the UK's ageing population at a time of funding constraints and cutbacks.