Financial sustainability of adult hospices in England

Public Accounts Committee Open Inquiry
Opened: 10 Jul 2025 Parliament page
In 2023, total UK hospice income of £1.8bn comprised around £0.5bn of state funding and the remainder from charitable sources. In 2023-24, many adult hospices reported financial pressures and the threat of needing to cut services by up to 20% unless additional funding was given. An estimated 300 out of … Read more
16 Recommendations
14 Conclusions
1 Report
1 Oral session
6 Letters
1 Event
Activity timeline 8 events
6 Jul
2026
Correspondence
20 Apr
2026
Correspondence
26 Mar
2026
Correspondence
18 Mar
2026
Report published
26 Jan
2026
Correspondence
26 Jan
2026
Correspondence
26 Jan
2026
Correspondence
12 Jan
2026
Oral evidence
Oral evidence sessions 1 session
12 Jan 2026
View on parliament.uk
Dr Amanda Doyle OBE · NHS England Dr Edward Scully · Department of Health and Social Care Duncan Burton · NHS England Professor Fliss Murtagh · Hull York Medical School Samantha Jones · Department of Health and Social Care Sir James Mackey · NHS England The Baroness Finlay of Llandaff Toby Porter · Hospice UK
Title HC No. Published Items Response
73rd Report - Financial sustainability of adult hospices in Engl… HC 1236 18 Mar 2026 30 Responded
Recommendations & Conclusions
30 results
2 Recommendation Rejected
73rd Report - Financial sustainabi…
Only now are the Department and NHS England developing a Modern Service Framework for palliative...
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 … Read more
Government Response
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.
HM Treasury
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3 Recommendation Accepted
73rd Report - Financial sustainabi…
NHS England has been too slow to enforce a commissioning approach for the provision of...
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 … Read more
Government Response
NHS England published statutory guidance for palliative care and end-of-life care, as well as service specifications. 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.
HM Treasury
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4 Recommendation Accepted
73rd Report - Financial sustainabi…
Too many patients spend their last days receiving palliative care in acute hospitals, which does...
Too many patients spend their last days receiving palliative care in acute hospitals, which does not always achieve the best outcomes for patients nor represent value for money. Patients are frequently receiving palliative care and reaching the end of their … Read more
Government Response
The government is developing a Palliative Care and End‑of‑Life Care MSF which will support the shift to strategic commissioning based on integrated needs assessments and will outline evidenced based interventions. It will also build on the recently published Neighbourhood Health Framework, which sets clear expectations for the improvement of care of palliative care and end-of-life care patients through Neighbourhood Health.
HM Treasury
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5 Recommendation Accepted in Part
73rd Report - Financial sustainabi…
The Department and NHS England are not responding to the growing financial crisis in the...
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. … Read more
Government Response
The government agrees that ICBs should ensure financial stability of hospices in their footprint and the steps being taken to mitigate risks, but disagrees with developing an individual plan for each independent hospice.
HM Treasury
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6 Recommendation Rejected
73rd Report - Financial sustainabi…
The NHS is at risk of losing the huge value it gains from independent hospices...
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 … Read more
Government Response
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.
HM Treasury
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7 Recommendation Rejected
73rd Report - Financial sustainabi…
Hospice collaboratives have the potential to deliver efficiencies and further raise the quality of care,...
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 … Read more
Government Response
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.
HM Treasury
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1 Conclusion Accepted
73rd Report - Financial sustainabi…
On the basis of a report by the Comptroller and Auditor General, we took evidence...
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (the Department) and NHS England on the provision of palliative and end-of-life care, and the funding of … Read more
Government Response
The government agrees with the committee’s recommendation: service specifications for adults and children and young people, outlining expectations of what palliative care and end-of-life care services are commissioned.
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8 Recommendation Accepted
73rd Report - Financial sustainabi…
The NAO reported that the mix of funding mechanisms varies between ICB areas, largely comprising...
The NAO reported that the mix of funding mechanisms varies between ICB areas, largely comprising a mix of historic grants and block contracts with few examples of activity-based contracts used in a strategic commissioning approach.11 Progress in moving towards strategic … Read more
Government Response
The government agrees with the committee's recommendation to address slow progress in strategic commissioning and reform funding mechanisms, with an implementation target of Autumn 2026. It plans to use the Palliative Care and End-of-Life Care Modern Service Framework (MSF) to strengthen commissioning and improve sustainability by moving away from grant and block contract models, and has already published related guidance.
HM Treasury
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9 Recommendation Accepted
73rd Report - Financial sustainabi…
NHS England told us that although it does collect patient-level activity data, it needs to...
NHS England told us that although it does collect patient-level activity data, it needs to start collecting more. It currently does not collect activity data from all hospices and therefore cannot determine how much care ICBs are buying from hospices, … Read more
Government Response
The government accepts the recommendation to improve data collection and address the over-reliance on charitable funding for hospices. It plans to achieve this through the Palliative Care and End-of-Life Care Modern Service Framework (MSF), slated for Autumn 2026, and the Strategic Commissioning Framework, which will strengthen commissioning and facilitate a move away from grant and block contract models.
HM Treasury
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10 Conclusion Accepted
73rd Report - Financial sustainabi…
There has not been a renewal of the government’s approach to delivering and improving palliative...
There has not been a renewal of the government’s approach to delivering and improving palliative and end-of-life care in England since the first national strategy was published in 2008. The Health and Care Act 2022 introduced a legal duty for … Read more
Government Response
The government agrees with the committee's observation and is developing a Palliative Care and End-of-Life Care Modern Service Framework (MSF) for monitoring strategic commissioning. NHS England has already published guidance and frameworks, and will work with some ICBs to develop new payment models by Autumn 2026.
HM Treasury
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11 Conclusion Accepted
73rd Report - Financial sustainabi…
The terms and conditions in the independent adult hospice sector have diverged from those in...
The terms and conditions in the independent adult hospice sector have diverged from those in the NHS, with clinicians in hospices often earning less than their NHS counterparts.18 We heard from Hospice UK and NHS England how hospice provision is … Read more
Government Response
The government agrees with the committee's finding, stating that ICBs have a duty to commission palliative care, supported by statutory guidance and NHS England's new strategic commissioning framework. This framework, with a target implementation date of Autumn 2026, aims to address governance issues in hospice provision.
HM Treasury
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12 Recommendation Rejected
73rd Report - Financial sustainabi…
The Department and NHS England told us that data on patient-level activity from hospices, which...
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 … Read more
Government Response
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 Data Flows concerns.
HM Treasury
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13 Recommendation Rejected
73rd Report - Financial sustainabi…
The Department and NHS England told us about the ‘Modern Service Framework’ they are currently...
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 … Read more
Government Response
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.
HM Treasury
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14 Conclusion Rejected
73rd Report - Financial sustainabi…
The Department and NHS England are aiming to launch the framework later this year in...
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 … Read more
Government Response
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 without committing new funding.
HM Treasury
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15 Recommendation Accepted
73rd Report - Financial sustainabi…
ICBs currently fund hospices largely through grants and block contracts, which do not provide clarity...
ICBs currently fund hospices largely through grants and block contracts, which do not provide clarity over what is being purchased.28 The Department and NHS England acknowledged that there must be a move away from funding hospices in this way towards … Read more
Government Response
The government accepts the recommendation to move away from grants and block contracts towards a strategic commissioning approach for hospices. It plans to address this through the Palliative Care and End-of-Life Care Modern Service Framework (MSF), due for publication in Autumn 2026, which aims to strengthen commissioning and improve sustainability.
HM Treasury
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16 Conclusion Accepted
73rd Report - Financial sustainabi…
NHS England told us that ICBs are required to understand the needs of their populations...
NHS England told us that ICBs are required to understand the needs of their populations and their projections of future demand.30 NHS England acknowledged that it must take the lead on establishing a single commissioning approach for the provision of … Read more
Government Response
The government agrees with the committee's findings, detailing existing and planned initiatives by NHS England to support ICBs in strategic commissioning. These include a Strategic Commissioning Framework, statutory guidance, and a forthcoming Palliative Care and End-of-Life Care MSF by Autumn 2026.
HM Treasury
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17 Recommendation Accepted
73rd Report - Financial sustainabi…
Professor Murtagh stressed that ICBs need to commission on the basis of activity and outcomes.
Professor Murtagh stressed that ICBs need to commission on the basis of activity and outcomes. Professor Murtagh explained that this approach is already used elsewhere in the NHS through a blended payment model that aligns payments with incentives, and questioned … Read more
Government Response
The government accepts the recommendation for ICBs to commission palliative and end-of-life care based on activity and outcomes. It outlines multiple existing frameworks and guidance, commits NHS England to developing new payment models with ICBs, and plans for the Palliative Care and End-of-Life Care MSF (Autumn 2026) to monitor the shift towards strategic commissioning.
HM Treasury
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18 Recommendation Accepted
73rd Report - Financial sustainabi…
We are concerned that adult hospices do not benefit from multi-year funding settlements, as children’s...
We are concerned that adult hospices do not benefit from multi-year funding settlements, as children’s hospices do. NHS England agreed that this was an issue, and that it is working towards providing hospices with better certainty over funding over a … Read more
Government Response
The government accepts the recommendation, agreeing that multi-year funding is an issue. It plans to address this through the Palliative Care and End-of-Life Care Modern Service Framework (MSF), slated for publication in Autumn 2026, which aims to strengthen commissioning and move away from current funding models.
HM Treasury
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19 Conclusion Accepted
73rd Report - Financial sustainabi…
Professor Murtagh told us that for a long time it has been known that around...
Professor Murtagh told us that for a long time it has been known that around one in four adults who need palliative care do not get it, and that recent research suggests that the proportion may now be even higher.36 … Read more
Government Response
The government accepts the implied recommendation to improve access to palliative care and shift care out of acute hospital settings. It plans to achieve this through the Palliative Care and End-of-Life Care MSF by Autumn 2026, which will include metrics to reduce avoidable hospital admissions and unnecessary bed days, building on existing frameworks with a 10% target for these improvements.
HM Treasury
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20 Conclusion Accepted
73rd Report - Financial sustainabi…
The Department and NHS England agreed that there are gaps in provision of palliative and...
The Department and NHS England agreed that there are gaps in provision of palliative and end of life care and that it must meet demand where it is needed.39 They also acknowledged the importance of moving care away from costly … Read more
Government Response
The government accepts the implied recommendation to address gaps in palliative and end-of-life care provision and to rebalance funding away from the acute sector. It plans to achieve this through the Palliative Care and End-of-Life Care MSF by Autumn 2026, which will include metrics to reduce avoidable hospital admissions and unnecessary bed days, building on existing frameworks with a 10% target for these improvements.
HM Treasury
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21 Recommendation Accepted
73rd Report - Financial sustainabi…
Professor Murtagh stressed the importance of having earlier conversations with patients and their families about...
Professor Murtagh stressed the importance of having earlier conversations with patients and their families about possible deterioration and approaching death, to ascertain their wishes. Without such conversations, patients may continue to have high-cost treatment they may not benefit from.43 NHS … Read more
Government Response
The government agrees with the recommendation, setting an Autumn 2026 target implementation date, and is developing a Palliative Care and End-of-Life Care MSF and building on existing frameworks to support earlier conversations and advanced care plans for patients.
HM Treasury
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22 Conclusion Accepted
73rd Report - Financial sustainabi…
Some hospices have recently reduced the volume or range of services they provide and others...
Some hospices have recently reduced the volume or range of services they provide and others are planning to do so, at a time when demand for palliative and end-of-life care is rising.45 Hospice UK told us that hospices are facing … Read more
Government Response
The government accepts the implied recommendation to address financial pressures leading to service reductions in hospices. It details existing actions, including NHS England's request for ICB assessments on hospice financial stability, and ICBs' reported commitments to prevent service closures through various financial, operational, and governance measures.
HM Treasury
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23 Conclusion Accepted
73rd Report - Financial sustainabi…
NHS England emphasised that it is aware that every hospice provider is worried about financial...
NHS England emphasised that it is aware that every hospice provider is worried about financial sustainability, but that it is unaware of any hospices facing immediate closure.50 It told us it expects ICBs to undertake quality impact assessments if a … Read more
Government Response
The government accepts the implied recommendation regarding hospice financial stability. It outlines existing actions, such as NHS England requesting financial stability assessments from ICBs and ICBs' commitments to prevent service closures through various financial, operational, and governance actions.
HM Treasury
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24 Recommendation Rejected
73rd Report - Financial sustainabi…
NHS England agreed that the hospice sector is fundamentally in financial distress and that there...
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 … Read more
Government Response
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 MSF will aid long-term sustainability by moving away from existing funding models.
HM Treasury
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25 Conclusion Rejected
73rd Report - Financial sustainabi…
The NAO report describes how independent hospices offer additional services that are typically outside the...
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 … Read more
Government Response
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 the hospice sector, which implies an acknowledgement of their value.
HM Treasury
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26 Conclusion Accepted
73rd Report - Financial sustainabi…
Baroness Finlay emphasised the role that hospices have as an important source of expertise in...
Baroness Finlay emphasised the role that hospices have as an important source of expertise in palliative and end-of-life care, available to professionals in the NHS such as district nurses and care assistants.58 NHS England told us how hospices support training … Read more
Government Response
Despite stating disagreement with the conclusion, the government's response outlines strong support for hospices, including close collaboration on the Modern Service Framework (MSF) and substantial funding. It is providing £125 million in capital funding and approximately £80 million in revenue funding for children and young people's hospices.
HM Treasury
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27 Conclusion Rejected
73rd Report - Financial sustainabi…
The Department and NHS England stressed how hospices’ positioning within communities supports the development of...
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 … Read more
Government Response
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.
HM Treasury
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28 Conclusion Rejected
73rd Report - Financial sustainabi…
Collaboratives are groups of independent hospices within an ICB region, including Marie Curie, Sue Ryder...
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 … Read more
Government Response
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 the MSF.
HM Treasury
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29 Conclusion Accepted in Part
73rd Report - Financial sustainabi…
We received submissions from three collaboratives: Lancashire & South Cumbria Hospices Together, Greater Manchester Hospices...
We received submissions from three collaboratives: Lancashire & South Cumbria Hospices Together, Greater Manchester Hospices Provider Collaborative, and Cheshire & Merseyside Hospice Provider Collaborative. They described how as collaboratives they can present a united voice to the ICB and are … Read more
Government Response
Despite stating disagreement with the conclusion, the government recognises the important role of hospice collaboratives and is considering how to support and spread these models through the MSF. However, it explicitly rejects dictating the working practices or operating models of independent hospice organisations.
HM Treasury
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30 Recommendation Rejected
73rd Report - Financial sustainabi…
NHS England told us about the West Yorkshire collaborative, which it considers to be the...
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 … Read more
Government Response
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 MSF, and will identify and share examples nationally.
HM Treasury
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Government Response AI assessment · 30 of 16 classified
Accepted 17
Accepted in Part 2
Rejected 11
Total 16 recs + 14 conclusions
Correspondence 6 letters
6 Jul 2026 From committee Letter to the Permanent Secretary at the Department of Health and Social Care and the Chief Executive of NHS England relating to Treasury Minute response – Financial sustainability of adult hospices in England, 6 July 2026
Parliament page
20 Apr 2026 To committee Letter from the Permanent Secretary of NHS England to the Chair of the Public Accounts Committee relating to Financial stability of adult hospices in England, 30 March 2026
Parliament page
26 Mar 2026 From committee Letter to the Permanent Secretary at the Department of Health and Social Care relating to Financial sustainability of adult hospices in England, 26 March 2026
Parliament page
26 Jan 2026 To committee Letter from the Chief Executive Officer of Hospice UK relating to the Committee’s evidence session on 12 January 2026 on Financial Sustainability of Adult Hospices, 15 January 2025
Parliament page
26 Jan 2026 To committee Letter from the Chief Executive Officer of NHS England relating to the Committee’s evidence session on 12 January 2026 on Financial Sustainability of Adult Hospices, 16 January 2026
Parliament page
26 Jan 2026 To committee Letter from the Chief Executive Officer of Sue Ryder relating to the Committee’s evidence session on 12 January 2026 on Financial Sustainability of Adult Hospices, 16 January 2026
Parliament page