The Guardian view on hospices: investment in end-of-life care is a national priority | Editorial

EEngland’s first modern hospice, established with the aim of improving the quality of life of terminally ill people, opened as a charity in south-east London in 1967. Its guiding philosophy was poignantly summed up by Cicely Saunders, the nurse and social worker who founded it: “You matter because you are you, you matter until the last moment of your life.”

Since then, through a combination of donations, fundraising efforts and financial support from the NHS, the independent palliative care movement has become a key part of the UK care economy. Providing emotional and medical support to the terminally ill and those suffering from life-limiting illnesses, and providing services to those who wish to remain in their own homes, palliative care is an invaluable social asset. On both sides of the tense parliamentary debate over the assisted dying bill, the need to ensure good palliative care is an option available to all has been taken as a no-brainer.

All of this makes the National Audit Office’s report into the financial viability of the adult palliative care sector in England worrying reading. A heavy reliance on charitable sources already means that a postal lottery applies to the provision of palliative care, thus favoring wealthier areas. In its report published on Wednesday, the NAO describes a worrying financial situation at all levels.

Nearly two-thirds of independent hospices reported a deficit in 2023-24. Declining donations, the impact of inflation and rising labor costs are leading to a reduction in the number of beds and staff layoffs. Services providing psychological and bereavement support are being cut and some hospices are reducing their in-home services.

This is simply sad news. A significant number of people who would like to receive palliative care already do not have access to it. An aging population, in which people are living longer with more complex health problems, means demand will only increase. As Gareth Davies, head of the NAO, observed on Wednesday: “As more people are expected to want palliative care in the future, it is crucial that the sector is financially resilient. »

The Department of Health and Social Care this month committed to a three-year funding deal for children’s hospices and provided a one-off £100 million bailout for capital spending in the adult sector. But much more must be done to strengthen and energize the institutions stemming from the best of the voluntary tradition. Complementing the state, hospices play a vital role in improving community wellbeing, reducing suffering and saving money for the NHS.

Safeguarding the future may involve rethinking current arrangements, in which the majority of hospice funding relies on charitable contributions. The prospect of a state-funded assisted dying service alongside a cash-strapped palliative care sector is deeply worrying. Rising debts suggest that this is nonetheless a real possibility.

For the government and the country as a whole, the NAO report should be a wake-up call. Current provision of end-of-life care remains uneven and subject to a postcode lottery, but the future must be about expansion rather than retrenchment. Following Saunders’ groundbreaking work in the 1960s, the value of hospices to the NHS was only gradually recognized and recognized. Warm words about the value of the sector and the qualities of the dedicated staff who work there must be followed by action.

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