Background
Hospice care aims to improve the lives of people who have an incurable illness, providing an alternative to hospital care for people at the end of their life. Almost all hospice care is provided by the over 200 independent charitable hospices in the UK, which are outside of the NHS but support it to meet its duty to provide end-of-life care. There are also 21 state-funded NHS hospices. Around 20% of hospice care is provided in dedicated hospice buildings, with most care provided to people in their homes or other care settings.
Independent hospices on average receive about one-third of their income from the state, mainly through grants from integrated care boards in England and equivalent bodies in the other home nations, generating their remaining income through legacies, donations, investments and fund-raising. In 2023, total UK hospice income of £1.8 billion comprised around £0.5 billion of state funding and the remainder from charitable sources. Hospice care is largely provided free of charge.
In 2023-24, many hospices reported financial pressures and the threat of needing to cut services by up to 20% unless additional funding was given. An estimated 300 out of 2,200 hospice inpatient beds were lost due to a lack of funding.
This is against a background of the total number of annual deaths in the UK steadily rising due to the ageing population and increasing numbers of older people with co-morbidities, driving increasing demand for end-of-life care. In response, the government provided £100 million in capital funding to be distributed across the hospice sector in England, of which £25 million was distributed in 2024-25 and the remainder will be distributed in 2025-26.
Scope
The Department of Health & Social Care and NHS England have no statutory obligation to provide hospice care. However, the financial sustainability of independent hospices is important to them due to hospices’ role in the provision of end-of-life care. This investigation will examine the hospice sector in England, with a focus on:
- the structure of, and trends in, funding for hospices and the financial state of the sector
- variation in accessibility to hospice care
- plans to address financial and accessibility challenges across the sector
NAO team
Director: Lee Summerfield
Audit Manager: Andy Whittingham