This article began as a light-hearted attempt to mock a clumsily-worded or ill-conceived target that has recently been set for the NHS. It is part of Wes Streeting’s oft-touted plan for the NHS to be remodelled around “neighbourhood health centres”.
The government’s Neighbourhood Health Framework, published in mid-March, claims to be “central to the continuing effort to regain public confidence in the NHS.” But one of the targets it sets to be achieved by March 2029 is to:
“increase the number of people identified as approaching end of life by 10%”.
At first sight, this is nonsense. How can it win public confidence, or be seen as progress, for doctors to define more people as being at death’s door? Surely the whole purpose of the NHS is to maximise healthy life, not increase the numbers who are about to leave it?
Adding to the number of people branded as being on their final countdown is even more vexed a question now, in the context of the ongoing debate on legislation to legalise assisted dying. Critics of the Bill have raised a number of concerns, not least the lack of sufficient palliative and hospice care, as factors that might push more people to opt for an early exit rather than endure months more pain.
But I saw the new target this way because I had first seen it (along with the linked target for “a 10 per cent reduction in [end of life patients’] non‑elective admissions and bed days”) summarised in the Health Service Journal.
The HSJ summary makes it appear that the plan is to increase the numbers identified, while also switching care away from patients at end of their lives, rather than improving it. That’s because the HSJ summary goes no further and gives no details of the linked policies and targets for end of life care that are included in the Framework document.
But as I checked out the full document, it became more obvious that, however bizarre the way it is explained, the issue is not a joking matter. End-of-life care is a serious and chronic failure of governments to deliver on fine words.
The Framework document begins with a commitment to “more effectively co-ordinating services for those with the most complex needs, for example, those at end of life.” It links this with the development of new, “modern service frameworks” covering cardiovascular disease, sepsis, frailty and dementia, severe mental illness, children and young people, as well as “palliative and end of life care,” which is due to be published later this year.
57% of hospices completing the survey had already made, are planning or considering cuts to frontline services this year.
According to Hospice UK’s financial benchmarking report, quarter ended 31 December 2025, completed by 107 hospices.
Goal 1 of the Framework is to set objectives, which include reducing excessive hospitalisation of “people with mid to severe frailty, in a care home or housebound,” and working instead to help them stay healthier, manage escalating conditions and maintain greater independence for longer.
In a similar fashion, the Framework also seeks to “better identify people coming to the end of life and improve access to services so people can die in a place of their choosing.”
All this seems quite reasonable as far as it goes.
But delivering on this promise is much more complicated and expensive than the Framework suggests. The current NHS guidance tells end of life patients:
“You have the right to express your wishes about where you would like to receive care and where you want to die. You can receive end of life care at home, in a care home, hospice or be cared for in hospital, depending on your needs and preference.”
The option to be cared for in hospital is increasingly being excluded by the new Neighbourhood Health Framework, while the availability of the other options depends on where you live, the policies of the relevant Integrated Care Board, the availability of adequate council-run social care services … and the availability of voluntary sector and charity-funded hospices.
Indeed, the new Framework tacitly accepts this situation. It is largely devoid of specific or concrete commitments to any NHS-wide standards. Instead of any instructions to change and improve access it is couched as a request:
“Nationally, NHS England will ask ICBs to ensure INTs [Integrated Neighbourhood teams] are set up with an initial focus on people with frailty, and those who need end of life care”.
However, the explanation of why these groups are the priority is chilling:
“Those over 75 living with frailty, those at end of life and care home residents account for 3 to 5% of the population yet represent over 25% of non-elective admissions and 50% of bed days.”
The explanation makes it appear that the targets for end-of-life care are driven by finance and resources rather than patients’ needs and wishes. NHS England is trying to cut costs and free up beds for other (waiting list) patients, rather than provide a genuine choice for patients nearing the end of life.
This is confirmed by the very modest improvements being proposed for access to community health services. Capacity is to be increased “to meet demand growth (around 3% per year nationally).” Measures include increasing capacity and “actively managing” long waits. But the Framework document does not allocate any additional funding for this expansion, leaving its future in doubt.
Indeed, it explicitly states that Neighbourhood Health must be funded by “rebalancing existing resources rather than relying on new funding”.
To make matters worse, the waits are currently so long that the new targets only call for at least 78% of community health service activity to be delivered within 18 weeks by 2026/27 (this year), increasing only slightly to at least 80% by 2028/29 – backed up by “new ICB plans to eliminate all 52-week waits.”
Even if achieved, this seems likely to mean at least one in five of the patients needing community health care – and quite possibly an even larger share of patients defined as “end of life,” and therefore potentially with more complex needs – would be kept waiting 3 months or more for the support they need to live independently.
According to the NHS, people are considered to be approaching the end of life when they are likely to die within the next 12 months: for these patients to be kept dangling for months on end before care packages are put in place is a long way from ensuring the prompt and holistic response that is needed, let alone offering patients the 4-way choice that current policy suggests end of life patients should have.
And it’s not just the choice of hospital care that is increasingly excluded by DHSC policy: hospices, the voluntary organisations which set out to offer a humane and caring combination of palliative care and support, are still mired in a chronic financial crisis, which threatens the continuity of services now in place and excludes any hope of expansion to meet demand.
Campaigning
On April 15 hospice staff from across England gathered in Westminster to demand urgent action on funding. Staff members, including nurses and leaders from hospices that have already been forced to make devastating reductions to services and staff redundancies, delivered a letter to the Prime Minister and met MPs, pressing for urgent financial support to prevent further cuts.
They pointed out that nearly 60% of hospices in England have already made cuts to frontline services, or are planning cuts this year. Hospice bosses have had to make staff redundant – and leave 380 hospice beds unused, because they can’t afford the staff to run them.
At neighbourhood level too, the cuts are also taking their toll, with the loss of 150,000 specialist community visits by hospice staff in a year.
The hospices have been left to fend for themselves, raising an increasing share of their funding through charity fundraising. They are now uniting around a four-point programme to put the sector back on its feet financially
- Full funding of specialist palliative care provided by hospices
- Proper NHS contracts for hospices
(The hospices argue that all too often the state’s contribution to the cost of hospices’ services are through grants which don’t reflect the true cost, and which are based only on historical precedent: they want hospices to be on NHS contracts which are fair, multi-year, have regular reviews and increase in line with rising costs.)
- Funding to cover the cost of NHS pay rises for hospice staff
(Just as hospices need the security of proper NHS contracts, hospice staff deserve their pay and conditions to match those of NHS staff – which means hospices must receive the funding needed to ensure their staff keep pace with NHS colleagues.)
- National accountability for equitable provision of palliative care, wherever you live
Where you live should not determine whether you get the palliative care you need. Government must take action to guarantee fair, consistent provision across the country.
Ministerial response
Perhaps predictably, the lobby triggered no statement from the Department of Health and Social Care: but the issue of proper funding for hospices is far from new. There have been warnings and complaints from hospices over funding issues for years, with many having had to cut back when charity funding could not bridge the gap between costs and NHS funding.
Back in December 2024 Wes Streeting told MPs: “This government is determined to shift more healthcare out of hospitals and into the community, to ensure patients and their families receive personalised care in the most appropriate setting and palliative and end of life care services, including hospices, will have a big role to play in that shift.” But the announcement of an extra £100m in capital funding for the hospice sector over two years was not backed by any additional revenue to pay staff and keep beds open.
In June last year Hospice UK sounded the alarm, reporting that after a series of stakeholder interviews with professionals including hospice and palliative care staff, district nurses, pharmacists and district nurses, two-thirds of rural health and care staff responding to the report said there were not enough workers with the right skills to support people with life-limiting conditions.
Last July Mr Streeting said he disagreed with how much hospices are reliant on donations, given their ‘integral’ role within the healthcare system:
“I’ve never been comfortable with the extent to which hospices are reliant on the generosity of the public through donations to fund something that, I think, in today’s day and age is an integral part of the health and social care system.”
He added that the government would “do everything we can:” but this was not backed by additional capital or revenue.
Claims by Social Care minister Stephen Kinnock that: “End-of-life care is crucial to our 10 Year Health Plan and our fundamental shift of moving more care out of hospital and into the community. We will continue to support hospices so they can deliver their vital work,” were also made without any commitment to funding to keep these “crucial” services going.
Last October, the Liberal Democrats published a press release warning that 40% of hospices were planning cuts that could affect 12,000 patients – and that half of children’s hospices were saying they will “cut or stop providing end of life care altogether if new funding is not guaranteed in 6 months.”
Meanwhile, the problem has got worse and worse. And the squeeze on NHS funding has left Integrated Care Boards looking for savings by cutting back on continuing health care. Cash-strapped Trusts have also been cutting back on the community services for the elderly that are vital to deliver Labour’s promises to deliver more local care through the new Neighbourhood Health Framework.
Once again it seems Labour’s policy sadly continues 14 years of Tory policies rather than offering the promised change, and remains at the level of empty promises while focusing the least attention and resources on the patients with the greatest and most urgent health needs.
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