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 central to government’s objectives of providing more care in the community, reducing hospital utilisation and aligning with patient preferences.19 However, sector representatives wrote to us to say that system-level governance and national oversight arrangements have not evolved to reflect this role.20