Statutory funding had historically been a concern for hospices in the Kent and Medway region, with hospices receiving an average of 20% of their income from statutory sources. Individual hospices had tried to negotiate for more, with no success. There were strong concerns about hospices having to operate under a deficit.
With the development of the Kent and Medway Integrated Care System (ICS), it was clear that hospices needed to speak with one voice to gain more influence and be able to negotiate with commissioners.
The hospices set up a Kent & Medway Chief Executives group – an informal collaborative which is chaired by Helen Bennett, CEO of Pilgrims Hospice. The group worked together to write a letter to the Integrated Care Board (ICB), setting out their position and sharing activity data to support their case. This was followed with face-to-face meetings.
Outcomes
Two years later, the ICB offered hospices £1 million in extra funding for the year. The hospices accepted this offer, but on the condition that there would be an ongoing discussion about funding in the future. This has put hospices in a good position to negotiate further about a long term, sustainable funding plan.
Facilitators, challenges and advice
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Key facilitators
Helen Bennett has previously worked in the NHS, which means she is able to confidently navigate commissioning processes and already had some useful connections. There is now a statutory duty for Integrated Care Systems (ICSs) in England to provide palliative and end of life care, which has helped to raise the profile of hospice services.
The group mapped hospice services against the commissioning framework, which enabled them to demonstrate how hospices contribute to the wider health system. They used national and local data on funding and activity to support their case. They showed that statutory funding was relatively small compared to the cost of services hospices provide for the local system.
The group persevered to secure face-to-face meetings with commissioners and followed up on actions agreed. They were very clear that, if they did not receive more money, they would have to withdraw some services.
Challenges
Before forming the collaborative, the hospices had never really worked together before. They had to make time to build trust. As the representative of the group, Helen made sure everyone had the opportunity to agree what she was saying on their behalf.
Tips and advice
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Be strategic – an increase in statutory funding isn’t going to happen overnight so you need a long term plan.
Be persistent and consistent - keep repeating your message until you get what you need.
Find out what commissioners need – how does the system work and how can hospices support it?
Understand their data, costs, workforce and pain points. For example, in Kent & Medway the health system needed more inpatient beds. By providing inpatient support for patients needing palliative and end of life care, hospices can free up hospital beds for other patients.
Be assertive and tenacious - don’t be afraid to talk about the consequences of not getting the funding you need. Commissioners only have limited funds so they will be reluctant to move funds from other services if they think you can ‘muddle through’ or get money from other sources.
Future development
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The group hopes that, by securing sustainable funding for core palliative and end of life services, they will be able to channel charity fundraising income into community development work.
A key target for Kent & Medway ICS is to improve early identification of patients at the end of life. Hospices are ideally placed to help the ICS deliver this but need financial support to do so. The group is working with Social Finance on a business case that would enable them to be the lead provider.
