Almost one in five hospice beds in England is now closed or standing empty, despite growing demand for end-of-life care, a study by Oxford University researchers has found.
The analysis exposes a deepening funding crisis in the hospice sector – which its authors have described as “a national scandal.”
The new research, carried out by Professor Carl Heneghan, Director of the Centre for Evidence based Medicine at Oxford University and Dr Tom Jefferson, Senior Associate Tutor at the University of Oxford warns that shortages in end-of-life care mean increasing numbers of frail and elderly patients are dying “in pain, alone, often hungry and dehydrated,” while others are being admitted to hospital in emergency situations, adding pressure to already stretched NHS services.
The report, published on their blog post Trust the Evidence, estimates there are around 2,000 hospice inpatient beds nationally, but about 380 cannot currently be used because services cannot afford the staff and day-to-day costs needed to keep them open safely.
Without additional funding, the analysis warns that as many as 40 percent of hospices could cut patient care in the coming months, while more than half of children’s hospices may also be forced to reduce services – leaving over 12,000 terminally ill patients unable to access end-of-life care.
Researchers say the closures are being driven by financial pressure rather than falling need, with current funding arrangements pushing hospices to breaking point.
Despite delivering care that would otherwise be provided by the NHS, the report finds that hospices receive, on average, less than 36 per cent of their funding from government or NHS sources, with the rest raised through donations, fundraising events and charity shops.
According to the analysis, hospice and palliative care costs around £1.8 billion a year across the UK, covering staff wages, medicines, utilities, buildings and community services.
Of that total, less than £500 million comes from government funding, leaving charities to find more than £1.3 billion every year just to keep services running.
The sector recorded a combined deficit of £78 million in 2023–24, the report says, with the shortfall now likely to be close to £100 million as inflation and staffing pressures continue to bite.
It found that nearly two-thirds of independent hospices are operating at a loss, while one in five faces deficits of more than £1 million.
The report makes clear that beds are being shut not because they are not needed, but because they have become too expensive to staff and run.
Staffing accounts for the largest share of hospice costs, and providers are facing higher wage bills, recruitment difficulties and rising energy prices. The authors say government funding has failed to rise in line with costs, leaving hospices to absorb an ever-greater share of spending.
At the same time, charitable income – which provides the bulk of hospice funding – was badly hit by Covid lockdowns, when charity shops were forced to close and fundraising events cancelled. Although donations have partially recovered, the report says income has not rebounded fast enough to keep pace with rising costs.
As a result, many hospices say they cannot afford to staff every bed safely, leaving them with no choice but to close beds even as waiting lists grow.
The report highlights recent closures as evidence of mounting strain.
Last December, Richard House Children’s Hospice in east London closed after more than 25 years of supporting children with life-limiting conditions and their families. The report notes that less than a third of its funding came from the NHS, leaving it heavily reliant on charitable income.
Earlier this year, Marie Curie Hospice in Woolton, Liverpool, permanently closed its 26-bed inpatient unit, citing ongoing staffing and financial pressures.
The report was compiled by Professor Carl Heneghan and Dr Tom Jefferson as part of a wider review of health-care spending.
In commentary accompanying the analysis, they described the situation as “a national scandal,” saying hospices are carrying out “NHS work” without consistent NHS funding.
Dr Jefferson said: “This is unacceptable and appalling. It is nothing short of a national scandal. What kind of society are we living in where we cannot look after the most frail members of our society? Many will be dying in pain, alone, often hungry and dehydrated due to the loss of services. We are effectively throwing these people in the bin.”
And Prof Heneghan, who also works as an out of hours GP said: “I regularly see people who cannot get proper end of life care. It’s heartbreaking. And it can leave loved ones scarred for life. At this time every hour matters.
The report added: “Hospices do the most demanding job in the country – caring for people at the end of their lives. If you are in an NHS hospital, the state pays the bill. But if you are in a hospice doing NHS work, saving NHS money, you are expected to survive on proceeds from cake sales and charity shops. How can it be that one of the wealthiest countries in the world relies on charity to fund dignified death? If it is NHS work, it should be NHS funded.”
The authors argue that hospices save the health service money by keeping patients out of acute hospital beds, yet remain exposed to inflation, workforce shortages and fluctuations in public giving.
The report also examines the Government’s £100 million hospice funding package announced in December 2024.
While welcoming the investment, the authors note that it is largely capital funding, intended for buildings, upgrades and equipment – not the everyday costs forcing beds to close.
They warn the funding cannot be used to pay nurses, heat buildings or buy medicines, and say that without long-term reform, more beds and services are likely to be lost.
A Department of Health and Social Care spokesperson said: “Hospices do incredible work to support people and families when they need it most and are facing incredibly tough pressures.
“This government has made the biggest investment in hospices in a generation – £125 million – to improve hospice facilities and has committed £80 million for children’s and young people’s hospices over three years.
“We will soon set out how we will transform palliative and end of life care nationwide – ending the postcode lottery and ensuring every patient and family receives the quality care and support they deserve.”
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