Committee publication · Special Report · 28 November 2025 · HC 632
3rd Special Report – Expert Panel: Evaluation of Palliative care in England
From: Health and Social Care Committee
Inquiry: Palliative Care
Summary
This is the Health and Social Care Committee's third special report, presenting an independent Expert Panel evaluation of palliative and end-of-life care (PEoLC) in England. The panel assessed compliance with relevant legislation and guidelines across commissioning, delivery, community transition, workforce, and equity. Key findings highlight systemic fragmentation: commissioning varies by Integrated Care Board (ICB), creating a 'postcode lottery'; ICBs lack adequate data and funding for PEoLC; services are under strain; and significant inequalities persist across all aspects of care provision.
Key findings
- Commissioning priorities among ICBs are highly variable, creating a 'postcode lottery' in PEoLC provision with no national strategy or delivery plan guiding local decisions.
- Only 35% of ICBs report significantly understanding their population's PEoLC needs; most lack the data collection infrastructure to commission appropriate services effectively.
- Competing financial pressures and recent 50% cuts to ICB running costs result in insufficient PEoLC funding; services prioritise crisis response over planned, person-centred care.
- PEoLC services are under significant strain across all settings; patients and families struggle to navigate complex, fragmented systems and are rarely offered adequate advance care planning.
- Persistent structural inequalities disadvantage geographic areas, children's services, and underserved communities; specialist and generalist workforces face critical shortages exacerbated by insufficient education and training provision.
Recommendations
- Develop and implement a national PEoLC strategy and delivery plan with clear standards, supported by a formal accountability mechanism for ICB commissioning decisions.
- Mandate the use of standardised commissioning frameworks and disaggregated data across all ICBs to enable consistent measurement of population needs, service quality, and health inequalities.
- Increase sustainable, recurrent funding for PEoLC services with dedicated allocations for community care, 24/7 access, bereavement support, and social care commissioning.
- Establish clear governance for children and young people's palliative care, including dedicated paediatric PEoLC leads and transition support between child and adult services.
- Expand and mandate education and training in PEoLC across generalist and specialist health and social care workforces, particularly addressing critical workforce shortages.
- Implement targeted interventions to address systemic inequalities affecting geographic access, ethnicity, disability, and marginalised communities in PEoLC provision.
- Develop explicit social care commissioning standards and frameworks for PEoLC alongside health commissioning, with adequate funding parity.
Tone
CriticalTopics
Key actors
Health and Social Care Committee (Chair: Layla Moran), Independent Expert Panel (Chair: Professor Dame Jane Dacre), Integrated Care Boards (ICBs), NHS England, Department of Health and Social Care, Marie Curie, Hospice UK, Royal College of General Practitioners
Notable line
“Commissioning priorities amongst ICBs are variable, creating a 'postcode lottery' in the provision of palliative and end of life care services”
Key Quotes
“… a "fragmented system that fails to meet the public's preference for high-quality care at home, in care homes …”
“… sporadic and inequitable. It is different between areas and certainly different between ICBs.”
“… not currently held to a standard or held accountable for the provision of palliative and end of life care in their patch. There are no targets or reporting requirements for ICBs relating to PEoLC”
“… requires further development if it is to be fit for purpose in supporting ICBs with their statutory duty.”
“"even if the answer was yes, we wouldn't know".”
“… having to balance many underfunded areas of care. As a result, the ICBs that do recognise the value of palliative and end of life care services cannot find the funds to fill gaps locally.”
“If ICBs could help us, I truly believe they would.”
“Expenditure on people in their final year of life is disproportionately distributed towards unplanned hospital and emergency care services", which is "clearly at odds with what people want for themselves.”
Source · parliament.uk record ↗