A new report from the National Audit Office (NAO) (October 2025) warns that the government lacks clear understanding of how much it relies on independent adult hospices — and how sustainable they are as demand for palliative and end-of-life care rises.
Key Findings
- The Department of Health and Social Care and NHS England do not know how much hospice care is provided by independent providers, or how dependent the NHS is on them.
- In 2023-24, Integrated Care Boards funded around 40% of hospice expenditure (about £400 million).
- Two-thirds of hospices ran a financial deficit that year, with total spending exceeding income by £78 million.
- Fundraising returns are falling, with hospices now raising only £1.96 for every £1 spent.
- Many hospices have already reduced beds and staffing to cut costs.
- Demand is increasing as the population ages, putting further pressure on services.
Why It Matters
Independent hospices are essential to providing choice, comfort and dignity at the end of life — yet the system currently lacks clear oversight of how vital they are. Without stronger data and sustainable funding, the NHS could face growing pressure to fill service gaps.
What’s Needed
The NAO calls for:
- Better understanding of how much care hospices deliver and what services are at risk.
- Improved data sharing between hospices, NHS England and local systems.
- Clearer strategy to secure long-term financial stability for the hospice sector.
What does this mean more generally?
If funding and sustainability issues are not addressed, people at the end of life may face reduced access to hospice care, fewer choices about where they die, and greater pressure on NHS services. The End of Life Network aims to ensure that everyone can plan ahead, understand their options, and receive high-quality, person-centred care wherever they choose. By promoting advance care planning, collaboration across services, and public awareness, the Network helps individuals and families prepare for end-of-life decisions with confidence and dignity — even as the wider system faces increasing strain.
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