CUp to 600,000 people die in the UK each year – a figure that was higher during the pandemic but has since fallen. More than half are at home or in a care home; most of the rest are in hospital. But for around 28,000 people who need specialist terminal care (almost 5% of all deaths), a hospice is where they get it. A far greater number receive palliative care from community hospices (more than 80% of hospice work is delivered this way, through partnerships with the NHS). Staff also support the families of those who are dying, including children. But their valuable work is now at risk as the sector faces its worst funding crisis in 20 years.
Hospices are highly regarded and rightly so. The Care Quality Commission noted in 2017 that they more excellent care than any other service it regulated. Many more people would choose to die in hospice if they could. Yet palliative care has not traditionally been a high-status area of medicine. And like so much else that has to do with death, hospice tends to remain out of sight and out of mind until people need it.
Now that they have emerged from the voluntary sector, hospices rely on a combination of NHS contracts and donations. But rising costs and other pressures have led to overspending and left fundraisers unable to plug the gaps. Last month, Birmingham Hospice the equivalent of cutting 45 full-time jobs and closed a third of its beds. The sector’s umbrella charity, Hospice UK, says most of its 211 members are caught between NHS England and integrated care boards – with the former insisting that local commissioners be responsible for end-of-life care, while the latter complain they don’t have enough money. (In April, the Welsh government responded to shortfalls with an extra £4m for Wales’ 12 hospices.)
Last week, Lord Darzi was commissioned by Health Secretary Wes Streeting to review the state of the health service. So far, Mr Streeting has indicated that he intends to invest in primary and community services – which now receive less than 10% of England’s total £165bn NHS budget – and that he is determined to reduce hospital waiting lists. But if local practices are the crucial route into the health system (the “front door”, as Mr Streeting puts it), then hospices are an important way out. With annual deaths expected to rise by around 130,000 by 2040, the need for end-of-life care is growing. Lord Darzi should consider the NHS’s relationship with hospices as part of his mandate.
Palliative care is not a sexy topic. But a more open discussion about the needs of dying people, now and in the future, would be helpful. New national standards for terminal care have been developed by the sector and in a recent report by members of parliament. This could provide clarity and impetus for improvement. But a comprehensive solution will require the involvement of policymakers in government and the NHS in all four countries. As palliative care physician Rachel Clarke put it in her book Dear Life, a “cradle-to-grave” health service should take responsibility for helping people die in peace.