So how should the government fund hospice care?

One of the first acts of the new coalition government back in July 2010 was to announce the Palliative Care Funding Review (PCFR). This set out ‘to develop, for the first time, a per-patient funding mechanism for palliative care’ for those of all ages and to clarify what was and wasn’t the state’s responsibility to fund.

The review had three key aims.  To create a fair and transparent funding system, to deliver better outcomes for patients and to provide better value for the NHS.  These were to be achieved by ‘developing an NHS palliative care tariff based on need, a funding system which incentivises good outcomes for patients…and the commissioning of integrated care packages which stimulate community services.’ 

In the final report, the authors said ’The consequence of doing nothing is clear: ever widening inequities; more and more people not receiving the care they need; and a financial system which results in too many people being cared for in hospitals.’

In actuality, nothing really changed. None of the post-mortems of the last 14 years that I have read has mentioned the failure to fulfil this early commitment. We did see a statutory obligation related to the provision of end of life care. But the devolved systems the same government set up meant that the responsibility for delivering this fell upon commissioners, with no obligation for Westminster to provide the funds to enable it.  

Returning to the PCFR, several reasons have been given as to why the recommendations were never implemented. One is that the basic premise was flawed. You might be able to use  a tariff for a hip transplant, a pretty standard procedure for (almost) any human being. Using tariff(s)  to fund all aspects of palliative care is a totally different challenge, though they may be one element of a more strategic approach. 

As the PCFR report itself said, ‘the challenge is to develop a system which captures the variations of the many different people that need palliative care, at any stage of their journey.’ It is tempting to think that there may be one answer to this question. In practice given the numbers of people, needs and conditions, sectors and organisations involved, is this ever really going to be possible? 

So, just as a one-size-fits-all approach to care of the dying will never work, neither will the same approach to funding. Scottish hospices mixed (some would use stronger words) experience of their government pledge to meet 50% of costs is an example of this. So, wisely, Hospice UK – whose advocacy and campaigning on this issue has never been as strong - are looking carefully at a range of options that might be used. 

This is both in terms of the types of funding that might be used (obligated statutorily funded services, grants, index linked increases, currencies, early access to benefits for the terminally ill, personalised budgets etc) and what these might fund (provider alliances specified services, networks, individual organisations, AfC uplifts, individual people, etc) as well as the role of national Government within this. 

Underlying these may be certain principles and commitments such as some of those seen in the end of life and palliative care manifesto produced by Hospice UK et al. 

Defining and proposing these forms of funding and what they would cover would need a national review to be set up – but without the pre-determined model that the PCFR had. This could form an element of the Darzi NHS investigation? 

In the meantime, some short term answers are desperately needed to ensure that those hospices facing immediate financial crisis can avoid reducing their services, which will  clearly only put the NHS under even more pressure.

There are indicators that the new Government may be more inclined to work more positively with the third sector than the last. But as we all know the range of challenges facing the new administration are vast and the resources to tackle them very limited.

As Sarah Elliot NCVO CEO said in the recent Third Sector podcast, charities should show how they can help deliver on the government’s missions and policies through partnership working, not just ask for more cash. 

To ensure a real and lasting difference to end of life care may require compromises and changes by all involved, including hospices. For example, more strategic collaboration with their peers and other organisations. Social Finance’s recent article shows how social investment at a system level can make significant positive changes. 

To move towards the vision that many hospices share of bringing about the best end of life care for all (exact wording will differ) may mean that they will need to be prepared to amend their own mission in realising that. 

And it will definitely need a more strategic and joined up approach to statutory funding.