Small hospices ‘probably unsustainable’, says Mackey

The NHS England CEO told the Commons public accounts committee evidence session on the sector, held last week, that “an awful lot of rebuilding” was required for ICBs to develop clearer payment mechanisms for hospices.

He admitted publication of the new “modern service framework” for palliative and end of life care, which promises to overhaul the sector, including its funding, had now been delayed from spring to autumn. However, he said he still expected ICBs to work this year to “provide a clarity of direction about what will be commissioned over time”.

Sir Jim also said that “nobody [had] communicated directly with me about a hospice that is close to going out of business”, as hospice leaders on the panel warned many were at risk of shutting down.

ICBs should work to identify “where anyone is especially at risk of going out of business” and resolve this if it is “clearly attributable from under-commissioning from the NHS”, he said.

He added: “I think that what we will find is that it is a general underlying fragility – changes in the charity sector over recent years, cost pressures or small providers that are probably unsustainable in the medium term.

“Again, there is a range of actions where we can see that if people maybe worked together a bit more – share some functions, work as a collaborative – there might be a way through that, but none of us can guarantee that no one will go out of business, given existing circumstances.”

Pushing Sir Jim on the timing of the MSF, committee chair Sir Geoffrey Clifton-Brown said he was hearing “a certain degree of complacency”. He flagged that the delay – alongside the time it will take ICBs to alter their current commissioning arrangements – meant change will not take place until 2027-28.

Sir Jim responded: “There is then a more tactical, day-to-day question of how ICBs and local systems can solve problems as they arise, while these new mechanisms are coming into place. It is not the case that everything just stops and will wait for these things. It has to be actively managed in the meantime.”

ICBs mainly fund hospices through grants, which offer limited clarity on what they are commissioning, but are expected to shift to offering activity-based contracts.

Also speaking at the committee, Toby Porter, chief executive of Hospice UK, said he supports the funding shift, but cautioned that “the way hospices are funded now is so un-strategic that we are not even at first base”.

He added: “The rest of the NHS is already talking about moving to outcomes, whereas hospices just get a grant – a contribution – without accountability on either side. We believe that the most broken part of the system is the local commissioning of hospice care services.”

The planned funding shift in hospices mirrors the unbundling of block contracts throughout the NHS, pushed by Sir Jim, who has said block contracts do not offer enough clarity or accountability.

The MSF will look at issues including delays in identification of individuals approaching the end of life, inconsistent commissioning between ICBs and workforce challenges.