73rd Report - Financial sustainability of adult hospices in England

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.