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
17 results
Clear
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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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.
HM Treasury
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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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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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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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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