Hospices will face ‘tough decisions’ and could be forced to cut back nursing services following National Insurance (NI) increases announced in the Autumn Budget last month, Nursing in Practice has been told.
Industry experts are warning the additional financial pressures triggered by NI rises could have a ‘profoundly negative impact’ on lifeline and respite care that could cost the sector around £30m per year.
Employer NI contributions (NICs) are being increased from 13.8% to 15% following last month’s budget, with changes expected to start from April 2025.
Speaking on BBC Breakfast this morning Wes Streeting, health and social care secretary, acknowledged the ‘challenges’ that NICs could bring the hospice sector and said the government will have ‘more to say’ before Christmas.
This follows reports, first published in The Guardian, that hospices could expect ‘lifeline funding’ to manage financial pressures brought on by NI changes.
This week Nursing in Practice has been told of hospices facing additional costs ranging from £200k to £400k a year, following the budget announcement.
Paul Farthing is chief executive of Shooting Star, a children’s hospice provider that delivers nursing care across community teams, within an in-patient unit and in hospitals.
He told Nursing in Practice that demand for hospice nurses is increasing, with growing numbers of children living with more complex needs that can require care from multiple nurses.
Despite this rising demand, Mr Farthing says Shooting Star will not be able to scale up nursing services to meet demands because of the additional financial pressures brought on by the NI rise.
‘The increasing numbers of children with life-limiting conditions is raising the demand for Shooting Star’s services,’ he said.
‘The recent changes in National Insurance will cost our hospice alone around £200,000 a year, and this is money we will not be able to spend expanding our clinical team, including nurses, to help meet the demand,’ he said.
Mr Farthing warned that additional funding burdens could mean more children receive end of life care in hospital rather than in a hospice environment, placing further pressure on secondary services.
Reducing respite care
The need to scale-back nursing services could have a major impact on the day and night respite support that is a key part of the hospice sector.
Respite care is vital for the family and carers of terminally ill people, offering them a chance to rest and receive personal advice and support.
Mike Bartlett is deputy chief executive of Julia’s House, a nurse-led children’s hospice that also faces scaling down its respite services unless additional financial support is given.
Mr Bartlett explained that the changes would not mean cutting entire nursing services but could require ‘scaling down’ the services that are currently being offered, such as respite care and counselling services, or the amount of care nurses can offer.
This would mean ‘having to offer a little bit less’ which could have a ‘devastating’ impact on the families and children Julia’s House supports.
The hospice currently spends almost £4m a year on nurses and support worker staff, and according to Mr Bartlett, the NI increases could cost Julia’s House £242k per year.
‘If the decision [to increase NI] isn’t reversed, then certainly within the next six months they [hospices] will have to look very carefully at what they can and can’t offer,’ he said.
Adding: ‘Many hospices face tough decisions ahead.’
‘Abandoned and overwhelmed’
James Cooper is head of external affairs at Together for Short Lives, a children’s palliative care charity.
He told Nursing in Practice that hospices are facing ‘a perfect storm’ of reduced integrated care board (ICB) funding and increased demand for their services.
In fact, in 2023/24 children’s hospices received, on average, nearly 10% less funding from ICBs compared to 2022/23, and over a third (31%) less funding when compared to 2021/22.
‘If ministers do not support children’s hospices with the additional costs they will be bearing as a result of the rise in National Insurance contributions, the likelihood of children’s hospices needing to cut back on the lifeline care and support that nurses currently provide will increase,’ Mr Cooper said.
‘This would undoubtedly leave more families of seriously ill children feeling abandoned and overwhelmed.’
He urged the government to fund children’s hospices for the additional costs they will face from the rise in employer NI contributions, a view that was echoed by Mr Farthing.
Sector leads are currently urging the government to commit to maintaining £25m for children’s hospices as ringfenced, as well as for centrally distributed NHS England grant funding beyond 2024/25, and to ensure this funding increases by at least the rate of inflation to meet rising costs.
According to Hospice UK, the amount that hospices receive from government equals around one third of their income, with the rest being charitably funded.
Some 60 cross-party MPs have also signed an open letter to care minister Stephen Kinnock, demanding government provide emergency funding to the charitable hospice sector.
On Monday, the Terminally Ill Adults (End of Life) Bill was published. MPs are due to debate and vote on the bill on 29 November.
A department of Health and Social Care spokesperson said: ‘We want everyone to have access to high-quality end of life care and are aware of the financial pressures facing the hospice sector, and of the huge generosity of the British public, whose donations provide a significant proportion of hospice funding.
‘We are determined to shift more healthcare into the community and ensure patients and their families receive high-quality, personalised care in the most appropriate setting, and hospices will have a big role to play in that shift.’
