In this blog, Compton Care’s CEO, Rachel Overfield, shares thoughts on the narrative around hospice care and how it doesn’t need saving, it needs reimagining and transforming. 

There is a growing sense that hospices are in crisis. Funding pressures are real, demand is rising, and the need for high-quality palliative and end-of-life care has never been greater. But the future of hospice care cannot be framed only as a question of survival. It must be about transformation. We cannot keep asking for more money from government, communities and stakeholders without also reinventing what we do so that it meets today’s needs – not those of 40 years ago.

I came into the sector seven years ago after a long NHS career, where I had seen relentless change: a health service trying desperately to keep up with an ageing population, changing expectations, funding pressures and workforce gaps. When I moved into hospice care, whilst recognising the exceptional standards of care being delivered, I was struck by the sector’s lack of appetite for transformation and its poor resilience around funding. Obviously, there are exceptions to this and there are great examples too of hospice transformation that has led to greater resilience. This, in my opinion needs to become sector wide.

There is now a welcome national conversation about the future of hospice care, linked to a recognised need within government and NHS leadership to improve palliative care for everyone. As the population ages, more people are dying older and with more complex disease. Demand for specialist palliative care will only grow. More than 40% of people die in acute hospitals, often with significant costs linked to repeat visits and admissions in their last year of life. Most people do not want this. They want their final months, weeks or days to be spent in the place they call home, or somewhere peaceful and away from busy hospital wards. They want timely pain and symptom relief from specialists; access to people who know how to have difficult conversations and have the time to do so; and the chance for life, for whatever time is left, to be lived. The range of services offered by many hospices cannot be matched by the NHS, and it is this range that enables truly holistic care: care that supports life to be lived, while also enabling a peaceful and dignified death.

Hospices must be part of this conversation to show the value of what we offer and the role we can play in meeting rising demand for palliative care. We can do more.

Many hospices, like many organisations, are facing financial challenges. The cost of specialist care has risen, fundraising is becoming harder, and charitable organisations are competing for support from communities whose household budgets are already stretched.

We should not minimise these pressures. Nor should we shy away from making the case for fair and sustainable public funding for palliative care for all – including in areas of the UK where hospices do not exist, or where hospice services are limited. Most palliative care is delivered by the NHS, and hospices must not give the impression that only they can deliver gold-standard care. I have worked in hospital trusts where palliative care is exceptional, and I have seen GPs and community staff work tirelessly to support people at the end of life. Even so, the best NHS services cannot offer the full scope of services that hospices do. Any funding discussion should therefore recognise the importance of partnership and of fully funding palliative care wherever it is delivered.

But in the hospice sector, we need to talk about more than funding.

We need a new model of hospice care – one that retains everything precious about the hospice movement while being brave enough to evolve. That means taking specialist care into communities through virtual wards; reaching people and communities that have not traditionally accessed hospice support; intervening earlier, not only at the very end of life; and seeing hospices as centres of excellence and expertise that help people live well for as long as possible. It means keeping people out of hospital. It means structural change.

We need to bring the same ambition with which the hospice movement began and apply it to the challenges of today. We need to look at ourselves critically and solve our own problems, rather than constantly looking to others to solve them for us. Are we collaborating enough? Are we sharing costs? Are we being innovative enough? The answer to rising demand and financial challenge cannot be rooted in fear for organisational survival; it should be rooted in ambition for the future and a desire to ensure equitable palliative care for all.

And there are many reasons to be optimistic. Our communities support us tirelessly, our staff and volunteers are extraordinary, and our expertise is needed now more than ever. We have powerful stories to tell about hospice care, and we need to tell them so that more people understand what hospices offer and how the hospice sector could do more.

At Compton, we have been growing and innovating because we see this as part of the solution to financial challenge. We have introduced new, modern services; changed our workforce models; and explored new ways to generate income. Recently, we formed a collaborative with other hospices that is already succeeding where, individually, we had struggled. We are more financially resilient than we have been for many years although this is still dependent on the generous support of our communities.

I want the conversation about hospices to be less about survival and more about transformation, collaboration and ambition. That is where the future of hospice-based palliative care should be: not in preserving the past, but in reimagining hospice care so that more people can live well, die well and receive the support they need, when and where they need it.