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 widely using payment schemes that align payments with incentives and fund on the basis of activity and outcomes. The Department and NHS England cannot show whether the quality of life for patients receiving palliative care is improving, whether they receive care in the right setting, or that unnecessary hospital stays are being avoided. New tariffs, payment mechanisms and incentives are being developed to align funding with need, and the Strategic Commissioning Development Programme for ICBs is planned to launch in April 2026 alongside guidance through a strategic framework. However, there is concern in the sector that multi-year commissioning models are not being implemented quickly enough given the financial pressures hospices are facing. NHS England is relying on ICBs to address financial problems and drive change in their areas, but NHS England must itself lead the adoption of improved commissioning approaches given the problems are system-wide and very variable, and particularly while ICBs are undergoing significant restructuring. recommendation NHS England should set out its plan for supporting all ICBs to adopt a consistent commissioning approach for the provision of palliative and end-of-life care that focuses on high-quality care outcomes for patients.