Hospices across England are being hindered and many face additional costs under new NHS structures, according to a hospice charity.
Help the Hospices surveyed its member hospices in England between March and May about arrangements with clinical commissioning groups for the 2013-14 financial year.
The survey showed that under the new arrangements, commissioning - the process of identifying which healthcare services are needed in a local or regional area, purchasing these services and monitoring their delivery - has become more complex.
A quarter of hospices surveyed said they were working with four or more statutory commissioners, 38% were working with three or more, while one hospice reported working with eight separate commissioners.
The charity said many hospices are managing a mixture of arrangements and nearly a fifth of hospices surveyed said they had three or more different forms of agreements with commissioners.
The financial impact of the new commissioning and contracting arrangements on all hospices in England, primarily from new data reporting requirements, is estimated to be at least £3.2 million, the charity said.
Around half of hospices have signed or have been asked to sign an NHS contract.
This has meant hospices have been required to replace relatively straightforward service delivery agreements with a complex, lengthy contract that is not reflective of local needs and experience and which cannot be tailored to these, the charity said.
In many instances hospices felt that much of the standard NHS contract was not relevant for commissioning hospice care, particularly because the NHS is only part-funding the care being delivered.
On average only a third of hospice costs are covered by the NHS - although funding levels vary across the country - with the rest coming from charitable funds.
There was also evidence of poor commissioning practices. This included the use of short-term contracts - of six months up to a year - rather than the recommended three years.
In addition, most hospices reported frozen or reduced funding.
Nearly a fifth of those surveyed (18 per cent) said funding levels had fallen this financial year, and in some instances hospices had seen funding frozen for five years.
Jonathan Ellis, director of public policy and parliamentary affairs at Help the Hospices, said: “Our survey shows the new commissioning arrangements are hindering hospices.
“Many hospices are managing a hotchpotch of different funding arrangements, dealing with multiple commissioners, some only have short-term agreements and all are battling with increased levels of bureaucracy.
“This combines to create instability and extra costs for hospices, which in the long term will adversely impact on patient care.
“NHS England must take action to radically improve commissioning arrangements for hospices, particularly by encouraging commissioners to make greater use of the flexibility at their disposal when commissioning hospice care.”
A total of 127 hospices completed the survey, and there are 163 hospices across England.