Hospices in England ended the last financial year with a deficit of more than £70 million – more than double the previous year. Around 65% of adult hospices have less than 12 months’ reserves, and nearly six in ten hospices have already made, or are considering, cuts to frontline services.
Those figures, published by Hospice UK, are pretty shocking but what do they actually mean for people who rely on hospice care?
When we think about our local hospice, most of us think about the care it provides. The nurses who visit people at home. The inpatient unit. Support for families. Someone to talk to when things become difficult. Specialist care when someone is approaching the end of their life. The fact this is all provided at no cost to the patients or their families. We probably don’t think very much about the hospice’s finances, but perhaps we should.
Why do hospices need reserves?
Reserves aren’t simply money that a charity has sitting in the bank waiting to be spent. They are a financial safety net. Just as we might keep some savings to deal with an unexpected expense or a period when our income is reduced, hospices need reserves to cope with unexpected costs and fluctuations in income.
The problem is that many hospices are now having to use those reserves simply to keep providing the services they already offer, which just isn’t sustainable. Hospices are charities and depend heavily on the generosity of their communities. Charity shops, fundraising events, donations and gifts in wills all make an enormous contribution. Huge increases in the cost of living mean that donations are down and gifts in wills and legacies are fewer.
The cost of providing care has increased too. Staff wages, buildings maintainance, equipment purchase and servicing and the costs of everything from energy to insurance continue to rise. At the same time, more people need palliative and end of life care. So hospices are caught in a difficult position: demand is increasing, costs are increasing, but income isn’t keeping pace.
The Southern Hospice Group, which includes Martlets, St Barnabas House and Chestnut Tree House, reported a £3.7 million deficit in February 2026. The group said eight adult inpatient beds were closed because it could not afford to staff and run them
This isn’t just an accounting problem
When we hear that a hospice is struggling financially, it can sound like an accounting problem but it isn’t. Hospice UK reports that around 380 hospice beds are currently out of use across England, while specialist community hospice visits have fallen by 150,000 in a year. Nearly six in ten hospices are already making, or considering, cuts to frontline services.
Hospice care isn’t an optional extra
There is sometimes a perception that hospice care is an optional extra – something provided by charities when the NHS can’t or even that hospices are funded by the NHS. Hospices are an important part of our health and social care system. They provide specialist care, support people in their own homes, help families and carers, and can prevent people spending their final days in hospital when that isn’t what they want. They also support care homes, community teams and other professionals.
When hospice services are reduced, the pressure doesn’t simply disappear. It moves somewhere else. It may end up with the NHS, social care, care homes, families and unpaid carers. And ultimately, it can affect the person who is dying.
What happens if this continues?
This is perhaps the most worrying question. If hospices continue to run deficits and use their reserves to make up the shortfall, eventually there will be very little left to fall back on and we are already beginning to see what that looks like.
If the situation continues, we are likely to see more hospice beds closed, fewer specialist staff, fewer visits to people at home and more services restricted to those with the most complex needs. Some hospices may have to close services altogether.
Where do these people go when the hospice can’t provide that care? Often, back into an already stretched NHS.
That could mean more people being admitted to hospital because the support isn’t available in the community. It could mean people spending their final days in hospital rather than at home or in a hospice. It could also mean more pressure falling on families and unpaid carers.
Hospice UK has warned that once specialist staff and services are lost, they can be extremely difficult to replace.
And there is another problem. The need for palliative care isn’t going away. In fact, it is expected to increase as our population ages. So the danger isn’t simply that hospice services are reduced, the fact is is that the gap between the care people need and the care that is available is getting bigger.
Can we rely on fundraising to solve this?
I have seen first-hand how generous communities can be and how much people care about their local hospice. Donations, charity shops, fundraising events and gifts in wills are incredibly important. But there is a bigger question here.
Can we really expect an essential part of healthcare to rely so heavily on charitable fundraising? Hospice UK is calling for a more sustainable approach to hospice funding, including increased government funding. This is a conversation we all need to be part of because most of us will encounter end of life care at some point for ourselves or someone we care about. We can’t assume that the hospice services we have today will automatically be there in the same way tomorrow.
Sources: Hospice UK – financial sustainability of England’s adult hospices; Hospice UK – Behind the cuts: how hospice services are shrinking across England.
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