Background to the report
Independent hospices are charities that provide palliative and end-of-life care to local communities across the UK. They are key partners in the local and national health and care systems, led by the NHS, that provide such care. In 2023-24, the independent adult hospice sector provided around 251,000 people with palliative and end-of-life care, including approximately 1,227,000 community visits and support to around 69,000 family members, friends and carers of patients.
Jump to downloadsCharitable donations, fund-raising, legacies and retail activity generate most of the income spent on the care provided by independent adult hospices. Government funding, including from Integrated Care Boards (ICBs), forms the second largest source of funding for hospices, around 29% of the sector’s total funding in 2023-24. ICBs fund independent adult hospices in two main ways.
There are currently 135 independent adult hospice charities in England that serve local communities, each typically operating from a single hospice location. There are two national charities, Marie Curie and Sue Ryder, which provide the same range of palliative and end-of-life care services as local independent adult hospices and operate hospices at locations across England (five and seven respectively). Together, these comprise the independent adult hospice sector.
Scope of the report
This report examines the independent adult hospice sector in England, with a focus on:
- the distribution of hospices across England;
- trends in hospices’ funding, spend and delivery of services; and
- financial challenges across the sector.
We decided to examine adult hospices and not include hospices dedicated to supporting children only. While there are strong similarities between the two types of hospice, and some of the issues we examine are common to both, they differ in how they are funded and in the demographic pressures they face.
Conclusions
Over time, recognition of the importance of palliative and end-of-life care by DHSC and the NHS has improved, culminating in the specific inclusion of the requirement for ICBs to commission palliative and end-of-life care to meet their populations’ needs in the Health and Care Act 2022.
NHS commissioning of palliative and end-of-life care from hospices has not yet fully moved on from its historic use of grants to commissioning through contracts, meaning it is not always clear what services are being commissioned or whether local demand is being met. Equally, NHS commissioners are unable to fully understand how the funding they provide to hospices is being used to support patients and their families.
Standardising the commissioning and funding of palliative and end-of-life care from hospices across all ICBs would go some way to help with this. To ensure equity of choice of care for people at the end of their lives across England, ICBs need, with guidance from DHSC and NHS England, to understand what services they require and how best to use the funding they already spend on care for these people.
With the number of people in England who die each year increasing, and the key positioning of high-quality palliative and end-of-life care in the assisted dying debate, the sustainability of the independent adult hospice sector is of national importance.
Downloads
- Report - The financial sustainability of England’s adult hospice sector (.pdf — 959 KB)
- Summary - The financial sustainability of England’s adult hospice sector (.pdf — 125 KB)
- ePub - The financial sustainability of England’s adult hospice sector (.epub — 1 MB)
Publication details
- ISBN: 978-1-78604-638-3 [Buy a hard copy of this report]
- HC: 1378, 2024-26
Press release
View press release (29 Oct 2025)
