Our hospice is facing a funding shortfall of £2.5 million in 2024-25. This is due to chronically inequitable funding from Devon Integrated Care Board (ICB), the organisation that allocates government healthcare funding in Devon, combined with price hikes in everyday costs such as energy, fuel and food, and a large increase to our annual salary bill due to the uplift in NHS salaries in 2023-24.
We are incredibly grateful to our brilliant staff, volunteers, donors and supporters for the passion, commitment, and support they give to our hospice and our patients every day, without which Hospiscare couldn’t operate.
To provide clarity and transparency about our funding situation, we have collated information below to answer any questions or concerns. As the situation develops, we will update this page.
Questions and Answers on Hospiscare’s Funding Situation and Service Changes
Jump to section:
- Hospiscare’s financial picture
- Changes to Hospiscare’s services
- Other areas of the organisation
- What can be done to help?
1. Hospiscare’s Financial Picture
Why is Hospiscare facing a deficit?
Hospiscare receives just 15% of its service costs from the ICB, in comparison to the national average for hospices of 27%*.
This inequity in statutory funding, combined with the cost-of-living crisis, rising everyday costs and a large increase to our salary bill due to the uplift in NHS salaries, has resulted in a large projected deficit this financial year.
*N.B. Figures are based on the latest data from Hospice UK, the national membership body for hospices, and our most recent audited accounts, and will be updated as new data is published.
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What is the projected budget deficit?
For the financial year 2024-25, our budget deficit is projected to be £2.5 million based on current levels of services and costs. This is an unsustainable position that must be addressed. We are asking the Devon Integrated Care Board (ICB), which allocates government health funding in Devon, to fairly increase our funding to match what other hospices around the country receive. This would significantly reduce our funding shortfall, and Hospiscare would also save costs where possible and raise the remaining funds needed through our charity fundraising and retail activities.
The projected deficit of £2.5 million for 2024-25 won’t change until the next financial year. This is because some income and expenditure are uncertain. For example, we don’t yet know for certain what the NHS salary increase for this year will be or how our fundraising and retail income will perform. Some income areas may overperform, but some may underperform. We will do all we can to control our spending and not surpass this deficit, but due to the above, we can’t know the outcome for sure until the end of the financial year.
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Does Hospiscare have financial reserves?
As of March 2024, our free reserves were £6.1 million, which is equivalent to seven months’ operating costs. We have been relying on our reserves heavily over the last six months, and it is prudent for a charity to hold the equivalent of at least six months’ operating costs to help indemnify it from unexpected shocks outside of the charity’s control – such as a global pandemic.
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What percentage of donations made to the hospice go to care?
Eighty per cent of money received is spent on direct patient care. The remaining 20% is spent on providing education, training, and support to frontline staff, ensuring that our facilities are fit for purpose, and raising the charitable funds needed to pay for our services. This is in keeping with other charities and hospices in the charitable sector.
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At a time of a cost-of-living crisis, when all public services are under monetary pressure, why is Hospiscare worthy of an increase in funding?
Hospiscare is asking Devon ICB, which allocates government health funding in our county, to increase our funding in line with other hospices, so that the people of Exeter, central and east Devon have equitable and fair access to palliative care. This will enable our hospice to continue to care for local people with terminal illnesses.
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What is Hospiscare asking the Devon ICB for?
We are asking the ICB to fairly increase our funding from 2024/25 to match what other hospices around our region and the country receive.
In March 2024, Devon ICB responded to our public campaign for fair funding by awarding Hospiscare a one-off additional payment of £480,000 for the 2024-25 financial year. While a welcome step, unfortunately, this wasn’t enough to address our projected deficit this year, nor does it give us any security or foundation to plan for future years.
To address the chronic inequity that has created our deficit, we need a commitment from ICB to increase our statutory funding in line with other hospices. Sadly, we have not had any uplift to our core statutory funding grant for future years and so we must act now to reduce our costs to safeguard the future of the hospice.
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Why does Hospiscare get less contribution from the Devon Integrated Care Board (ICB) than other hospices?
The commissioning of services and allocation of funds are solely at the discretion of the Devon ICB. We have repeatedly requested a rationale from the ICB to explain why Hospiscare’s funding falls short of other hospices. We are yet to receive a satisfactory answer. We encourage anyone who would like to know from Devon ICB why this is the case to contact the ICB directly at [email protected].
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When was this situation first raised?
The inequity in our statutory funding was first raised with Devon ICB shortly after its formation in July 2022. Over the subsequent 18 months, we hoped it would be addressed, but that wasn’t the case.
In November 2023, we briefed hospice staff, patients, volunteers and supporters, and local media, that the combination of the inequity in funding and rising costs meant we were facing a funding deficit of £2.5 million in 2024-25 and that if nothing changed by January 2024, we would most likely have to review our services to cut costs and ensure the long-term financial viability of the hospice.
2. Changes to Hospiscare services
Which Hospiscare services have been affected?
In April 2024, we reduced the number of beds on our inpatient ward from 12 to 8 and reduced our weekend community nursing provision.
In June 2024, we consulted with clinical staff about changing one of our at-home care services, Hospiscare at Home, that operates in the Exmouth & Budleigh Salterton area and the Okehampton & Crediton area.
In July 2024, we confirmed that changes to the service would take place. From October 2024 it will become a rapid response at-home service that provides hands-on care to patients in their homes across all 1,028 square miles of our patch for up to three days at a time.
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What will the new at-home service look like? What are its benefits?
Our current Hospiscare at Home service operates in two areas of our catchment area only: the Okehampton & Crediton area and the Exmouth & Budleigh Salterton area. The new service will operate seven days a week across Hospiscare’s full catchment area and provide at-home care for patients experiencing acute symptoms or health issues in their last weeks of life, for up to three days at a time.
The new service will be a rapid response at-home care team made up of nurses, paramedics, and healthcare assistants. Their role will be to attend a patient at their home, rapidly assess the most appropriate care for the patient in accordance with the patient’s wishes, coordinate the patient’s ongoing care, and provide hands-on care for the patient in their home for up to three days. After this time, care will be transferred to another service, e.g. Hospiscare’s community nursing service or our inpatient ward, a hospital or NHS service.
The main benefit of the new service is that it will operate across the whole Hospiscare catchment area, which includes the greater Exeter area, east Devon, central Devon and north Dartmoor. This means all our patients will be able to access the service if needed. We anticipate we will be able to support more patients, and it is projected to save our charity £485,000 a year.
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Will the new service mean fewer patients can choose to die at home?
This service is designed to ensure patients receive care by the right person, in the right place, at the right time, and to continue to give patients the choice to die in their preferred place. Because it will operate over the entire Hospiscare patch, more patients should be able to access the service.
The new at-home care team is in addition to our existing Clinical Nurse Specialist service and our multi-disciplinary Supportive Care teams, which will continue to provide specialist palliative care visits to patients’ homes throughout our patch.
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What happens to the patient after the three days of care that’s available via this service?
The team’s aim during their time with the patient will be either to provide immediate end-of-life support to the patient and their family to enable a good death at home or to stabilise the patient and coordinate with other services to ensure the most appropriate ongoing care for the patient, e.g. via transfer to Hospiscare’s specialist community nursing service or to our inpatient ward, or to an NHS generalist community nursing service or to hospital. Our clinicians will have dispensation to flex or extend the three days of care in specific circumstances, for example if there are any concerns about patient safety or if it’s likely that the patient’s death is imminent.
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How will patients be cared for overnight?
Overnight care for at-home patients will remain as it is currently within our Hospiscare at Home service: patients at home will be supported by our advice line and an NHS or other community care service.
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Which services remain in place?
- Hospiscare’s Clinical Nurse Specialists will continue to provide specialist palliative care visits to patients’ homes and care homes across our full patch.
- Patients across our full patch can continue to access our inpatient ward in Exeter.
- Patients can access outpatient clinics led by specialist nurses and therapists.
- Patients and their loved ones can access our multi-disciplinary supportive care and our bereavement care.
- Patients and their carers and health professionals can call our specialist advice and support line.
- Our Hospiscare at Home service will continue in the Exmouth & Budleigh Salterton and Okehampton & Crediton areas until September. The new at-home service is due to start across our full patch after this time and we will work toward a smooth transition.
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How much will the change to our Hospiscare at Home service save?
This change will save our charity £485,000 a year.
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Why are some of our nurses at risk of redundancy?
Making people redundant is not where we wanted to be. Redundancy processes are always difficult and no one wants to be at risk of redundancy from a job they love. Sadly, the funding situation means the organisation must make very difficult decisions to safeguard patient care and ensure the hospice’s long-term future. We have already made changes elsewhere in the organisation, including to our support services, senior management team, ward and CNS service, that will save £800,000 this year. This change to Hospiscare at Home will save a further £485,000.
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How many people are affected?
The consultation process directly impacts the Hospiscare at Home team and these are the team members at risk of redundancy. There are some options for alternative employment in the new service and in other clinical teams and we will do all we can to redeploy affected colleagues into new roles. Until the consultation is complete, we don’t yet know how many people may be made redundant.
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Who made the decision to change Hospiscare at Home?
The decision to change our care for patients at home was made by our Senior Management Team and Board of Trustees, supported by our Clinical Leadership Team.
3. Other areas of the organisation
Are we making changes and savings elsewhere in the organisation?
Yes. As an organisation, we have been working hard to save as much money as we can. This includes lowering our energy costs as much as possible, reducing our senior management team by two posts, streamlining our support services – including making three roles redundant, reducing the number of beds on our ward and making changes to our weekend community care. These changes are projected to save our charity c.£800,000 this financial year.
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Why can’t the hospice raise more money to close the funding shortfall?
Nationwide, charity fundraising is in a challenging position within a tough economic climate. Our fundraising and retail teams are performing well, especially given the current climate, and are making a significant contribution to the hospice’s care, raising over £2.96 million in 2023/24 and have growth targets set for this year and the next three years to help reduce the deficit. However, there is a limit to what we can reasonably expect our local community, who are already so generous, to give.
We cannot expect to cover our deficit through the generosity of local people alone – we must also have fair statutory funding and we must be responsible in reducing our costs in line with available funds.
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How many senior managers does Hospiscare have & what are they paid?
All hospices have a senior management team that is responsible for the day-to-day operations of the organisation and making strategic decisions for the organisation. We have five people on our SMT.
Salaries for all senior people working within charities are reported on the Charity Commission website, along with the charity accounts.
In addition to senior managers, hospices must also have palliative care medical consultants onboard to provide specialist care to patients. Some hospices employ their consultants directly, as is the case at Hospiscare. Other hospices pay the NHS to provide this cover and in such cases these salaries are not reported to the Charity Commission in the same way.
Senior manager pay is set by the board of trustees and is benchmarked with market rates. Medical and other clinical salaries are dictated by set NHS salary rates that are agreed by government each year.
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Will Hospiscare have to close any of our clinical sites or facilities?
Hospiscare has clinical facilities at Searle House in Wonford, Exeter; Kings House in Honiton; Pine Lodge in Tiverton, and Highview in Exmouth. We will continue to review the use of all our sites to ensure they used most effectively and cost-efficiently.
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Will we have to close any of our charity shops?
As long as our retail outlets continue to raise funds for our charity they will not be at risk of closure. As with any charitable business venture, if sales drop and/or costs rise to the point that a premise is no longer a viable business decision we will need to take steps.
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Will we be changing any more services?
All our services have changed and evolved over our 42 years of operation depending on available resources, developments in healthcare and patient need. That will always remain true. As well as changing patient demographics, our whole national health and social care sector is volatile and politically uncertain and this will also have a bearing on any future changes.
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Is Hospiscare the only hospice in this situation?
Sadly, no. Other hospices across the country are in similar situation and are also having to reduce their services and make redundancies due to a lack of funding.
4. What can be done to help?
What can I, or members of the public, do to help?
Please visit the Hospiscare website for information on how to send an email on our behalf to the ICB or use this tool from Hospice UK to write to your MP to put fair funding for hospices on the agenda for the new parliament.
Over 80% of our care is provided thanks to the support of our local community. If you are able, please consider making a one-off or monthly donation to our charity, playing our lottery, shopping in our stores, or including a gift to Hospiscare in your will.
Thank you for reading and for your support of our local hospice. If you have any questions about our service changes, please email [email protected].