Accept The Government recognises the vital role that hospices play, alongside NHS services, in supporting people at the end of life. Through recent investment and wider reforms, we are taking steps to support both service provision and infrastructure, while maintaining the independence of charitable hospices as autonomous organisations that often provide care above and beyond statutory requirements. Addressing inequalities in access to palliative care and end-of-life care services therefore require a system-wide, collaborative approach. Strategic commissioning is central to the MSF, which will support the move towards sustainable and predictable models of funding for hospices in which equity should be a core objective of their commissioning. Through the MSF, the Government will support ICBs to review commissioning and contracting arrangements for palliative care and endoflife care, recognising the current mix of models across the hospice sector. A more strategic approach will help reduce reliance on shortterm grants and block contracts where appropriate, supporting greater sustainability and enabling providers, including hospices, to plan more equitably and effectively. As part of this work, areas of action have been identified for those commissioning and delivering services, with associated performance and outcome metrics under development to support system accountability. This will be taken forward through strategic commissioning rather than prescriptive funding conditions, with ICBs expected to work with hospices and other providers to understand population need and support more inclusive service models, in line with their duties to address health inequalities. As a first step, we have already written to ICBs recently to seek an update on hospice financial sustainability throughout England, and have also issued a system- facing letter setting out our expectations of key partners. This includes immediate actions, ICBs are expected to develop an integrated needs assessment, in line with the Strategic Commissioning Framework, to understand current and future population needs for palliative care and end-of-life care and to inform valueformoney commissioning, including an understanding of service utilisation and costs, consistent with the MediumTerm Planning Framework. We are therefore asking ICBs to move to sustainable contracting of adult and children and young people’s hospice services based on their integrated needs assessment. Initially this will involve the move away from short-term grant funding for adult hospice services from 2027/28. This will, in turn, enable all ICBs have clear and transparent contractual arrangements in place for commissioned hospice activity to meet population health need. NHS England will support this transition through refreshed statutory guidance and service specifications later this year; however, ICBs can begin now by commissioning hospice services on the basis of their integrated needs assessment. 15