Hospices are the backbone of modern palliative care, providing a dignified, safe, and compassionate respite to those with terminal and end of life conditions. In the UK, over 200,000 people are supported each year by hospices, the majority of which are funded partly by government funding through the NHS and partly by donation and fundraising. Hospices employ expert clinicians, nurses and palliative specialists who help patients reaching the end of their life to die in a dignified and pain free manner, normally amongst their nearest and dearest in a comfortable setting. Dying in a hospice context provides much more peace than in hospitals, where hospices are often arranged and designed to have a more homely, welcoming décor than wards in hospitals. To run all aspects of this vital service is costly, and there have been recent demands on hospices throughout the pandemic which risk the service stability altogether.
A recent report showed that the number of people relying on hospice care will increase dramatically in the next decade, with many hospice executives worried that fundraising demands may quickly become insurmountable. By 2030, it is projected that almost £1 billion will be required to run the palliative care sector, with less than half of that amount covered by NHS funding. That means more than half of that amount must be provided through fundraising and donations alone, something which is wholly unrealistic. The Sue Ryder organisation states that the government would have to fund up to 70% of the almost 1 billion figure to make what is demanded through fundraising alone sustainable. The charity states that in the short term, this will be more costly for the government, but cheaper still than allowing the collapse of the sector and the disastrous overspill into NHS services.
In November of 2020, an additional £125 million was provided for hospices as part of the winter coronavirus package from the government. Although this was a relief to many struggling hospices, especially those taking on patients who have developed poor health after coronavirus disease, these additional top-ups of money address acute issues, but not the longer -term problems which limit the sector. Charity bosses say a much larger sum is required to address issues in organisational structure, procurement of sustainable funding, outreach and training, and other aspects which allow growth, like any other business. However, in the wake of a pandemic which has tested NHS services, many beyond repair, governmental figures are likely to see low hanging fruit in preventive medicine, testing, screening programs and diagnostic medicine which prevent the diseases which cause individuals to need palliative care. Many call for reform and reorganisation of the social care and medical provision in the United Kingdom, but social shifts along with these changes are paramount to tackling the causative factors of diseases which predispose individuals to needing end of life care.
As with many situations in life, we may not understand why something is valuable or important until we experience something first hand. To those who have lost family in hospitals and in hospices, there can be a difference between the two experiences, with hospice deaths typically being more expected, planned and comfortable for the family of the patient. A worrying outcome of funding cuts could unfortunately be the lack of hospices in local areas of patients, meaning they have to travel afar to die in a chosen setting. Worse still, collapse of the sector without intervention could mean many patients may die in their homes, where care from community nurses is still outstanding, but may be more intrusive for the family and their loved ones when their time comes.