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 a strategic commissioning approach. However, they emphasised that transitioning to activity or outcome-based commissioning is a complicated process that would require a period to build the systems and mechanisms to ensure long-term sustainability and avoidance of the current position in the future.29