73rd Report - Financial sustainability of adult hospices in England

Key findings

• Independent hospices save the NHS approximately 1.5 million bed days and over £800 million annually by supporting around 20,000 people to die outside hospitals, yet receive only £420 million of their £1.2 billion annual spend from ICBs, with the remainder from charitable donations.
• The Department and NHS England lack clarity over what services ICBs fund from hospices because commissioning relies on grants and block contracts rather than activity or outcomes-based models, and patient-level data collection from hospices remains incomplete.
• The Modern Service Framework, expected in autumn 2026, is vague on detail and unlikely to address the immediate crisis—hospices are announcing service cuts for spring 2026 if additional funding is not found before the new financial year.
• Around 42% of deaths in England occur in hospitals where many patients would prefer not to be, while only 5% occur in hospices; 78% of end-of-life spending goes to acute sectors despite research showing community-based care often delivers better outcomes.
• Seven well-established hospice collaboratives across England demonstrate potential for efficiency and quality improvement through shared functions and coordinated planning, but lack central support from the Department and NHS England.

Recommendations

• The Department and NHS England should use the Modern Service Framework to define core palliative care services ICBs must commission, establish how much is delivered by hospices, and determine fair ICB funding levels.
• DHSC and NHS England should work with the hospice sector to develop and publish a fully costed delivery plan alongside the Modern Service Framework.
• NHS England should set out its plan for supporting all ICBs to adopt a consistent commissioning approach for palliative and end-of-life care focused on high-quality outcomes for patients.
• NHS England should explain in detail how it will move more palliative and end-of-life care out of acute settings into the community and the savings expected.
• NHS England should work with ICBs to establish which hospices face imminent service reductions, confirm quality impact assessments have been undertaken, and develop individual support plans for each.
• The Department and NHS England should ensure the Modern Service Framework thoroughly examines the full range of wider benefits independent hospices provide and how to protect and support these benefits.
• The Department and NHS England should set out what support can be given to hospices to develop collaborative operating models and implement collaboration in all feasible areas.

Key actors

Sir Geoffrey Clifton-Brown, Department of Health and Social Care, NHS England, Baroness Ilora Finlay of Llandaff, Professor Fliss Murtagh, Hospice UK, Integrated Care Boards, Marie Curie and Sue Ryder