News and Comment

A new commissioning deal for hospices

Wednesday 7 May 2014


Mark Jarman-Howe is Chief Executive of St Helena Hospice, Colchester and was a speaker at OPM’s recent seminar on end of life care

At St Helena Hospice, a well-established charity serving North East Essex, we receive about a third of our net funding from the NHS – which is about the same as the national average. This means that two thirds of our expenditure for things like patient and family services and palliative and end of life care education, comes from the generous support of our local community and our own income generation activities. Yet despite the untypical nature of our funding, the contractual and working relationship between St Helena and the local CCG – like that of many hospices –  remains that of the standard purchaser/provider split.

Like most hospices we offer a number of unique benefits to the local health economy. Firstly, we generate considerable social value by being the leading, and largest, local charity in the area, with a great reputation that generates considerable community goodwill and trust. This is something which many other NHS providers are unfortunately struggling to maintain in the context of austere public sector economic conditions and escalating demand (and public expectations).

Professionally hospices are the experts in palliative and end of life care, with an established holistic philosophy and ability to deliver truly integrated health and social care. Financially we invest more than £3 million of our own income each year direct into local services; more than the CCG spends on palliative and end of life services in the community in total. We also mobilise over 1,000 volunteers in support of palliative and end of life care, who contribute the equivalent of another £1.3 million to the local economy through their time and expertise. We follow a social, outcomes-based mission rather than bottom line or profit driven approach to delivery. We also offer benefits to commissioners because of our legal status as charities, such as the flexibility to receive and distribute income and expenditure over a number of financial years; autonomy from arbitrary national targets and bureaucracy; and, where we believe in the best interests of our constituents, a potentially higher risk-appetite than other providers.

Given this, I believe that the relationship between hospices and commissioners would be vastly improved, and the services offered to patients enhanced if, hospices were not treated as just another provider of services, but rather a trusted partner and co-commissioner aligned to long-term strategic goals.

Taking this approach hospices would be empowered to be more proactive and to take on a wider responsibility for the quality of and equitable access to palliative and end of life care in their localities. We need to remind our commissioners of the unique benefits we offer and go to them with solutions that are pitched in a language that they can relate to and that help address their challenges as well as those of the wider community. This means moving away from an over-reliance on qualitative benefits, and a track record of regulatory compliance to make our case, and instead translating our impact into avoided admissions, avoided A&E attendances and reduced acute excess bed days; after all the investment we want to see in the community can only come from unlocking resources being sucked into the acute sector.

This approach will be just as challenging for us as it will be to commissioners. Hospices will have to learn to a change their culture, build trustee engagement and understanding of the wider health and social care agenda, and to develop commissioning, contractual and business intelligence capability needed to co-commission. Commissioners in turn will have to learn to relinquish control and prove themselves open to an alternative procurement process premised on a more mature relationship with hospices. I for one believe that with the right attitude, approach and relationships it will be possible to negotiate a new deal.