The House of Commons Public Accounts Committee – chaired by Sir Geoffrey Clifton-Brown MP – has published an important report on the financial sustainability of adult hospices in England. The following findings have been drawn to my attention.
The report says there is an urgent need for reform to address the financial challenges facing the independent adult hospice sector.
The report notes that the Government seems to expect hospices to maintain service levels even if a hospice reduces its services or risks failure.
Furthermore, the Modern Service Framework is at least a year from introduction, which is not good enough in the face of widespread service costs.
The report draws the following conclusions:
- The Department and NHS England do not have effective oversight of the independent hospice sector.
- Only now are the Department and NHS England developing a Modern Service Framework for palliative and end-of-life care, but the details remain unclear.
- NHS England has been too slow to enforce a commissioning approach for palliative care provision that focuses on patient outcome quality.
- Too many patients spend their last days receiving palliative care in acute hospitals, which does not always achieve the best outcomes for patients nor represent value for money.
- The Department and NHS England are not responding to the growing financial crisis in the adult hospice sector with the seriousness and urgency needed.
- The NHS risks losing the huge value it gains from independent hospices.
- Hospice collaboratives have the potential to deliver efficiencies and further raise the quality of care, but their development lacks central support from the Department and NHS England.
The report draws the following recommendations:
- The Department and NHS England should use the opportunity of the Modern Service Framework to define the core palliative care services that ICBs have a duty to commission, establish how much of this hospices deliver, and determine fair levels of ICB funding for hospices.
- DHSC and NHS England should work with and incorporate the views of the hospice sector to develop and publish a fully costed delivery plan alongside the framework.
- NHS England should set out its plan for supporting all ICBs to adopt a consistent commissioning approach for the provision of palliative and end-of-life care that focuses on high-quality care outcomes for patients.
- NHS England should explain, in detail, how it will move more palliative and end-of-life care out of acute settings and into the community, and the savings it expects this will deliver.
- NHS England should work with ICBs to establish which hospices are forecasting imminent service reductions and confirm that for each of these the ICB has: undertaken a quality impact assessment; developed an individual plan for each such hospice, and set out how the ICB will support the hospice to maintain its services, or how the ICB will otherwise compensate for the service reductions.
- The Department and NHS England should ensure the Modern Service Framework will thoroughly examine the full range of wider benefits that independent hospices provide and that the NHS gains from; and how the Department will protect and support the provision of these benefits in the future.
- The Department and NHS England should set out what it can do to support hospices to develop existing collaborative operating models to derive as much financial benefit and service improvement as possible, and to implement collaboration in all areas where it is feasible.
