Hospice Lotteries AssociationAnnual Conference

Funding Hospice Care : What does the future look like?

Sarah BrocklebankChief Executive

12th September 2012

Overview• Hospice services• NHS funding• Hospice lottery funding• Total funding & its implications• My “ideal” characteristics of income streams• Looking forward • The future?

Hospice services• Independent hospices provide over 80% all palliative care services

in the UK

• 220 adult in patient units & 42 children IPUs

• Not just a building – community services of increasing importance

• £1.4m spent on hospice services in UK each day

• Total income for hospices range £1m - £10m

NHS current funding structure• NHS average contribution (England)

– Adult hospices = 34%– Children’s hospices = 15%

• Average NHS funding in Wales 24%, N Ireland 30%, Scotland 39%

• NHS funding largely historical and predominantly grants although contracts emerging

• “Joe Public” is funding hospices c £1m per day

What about hospice lottery income?• Average net profit per hospice £228k (based on 114 lotteries)• Average profitability 51% (compared to retail income at c 30%)• Huge amount of support from public – and hard work from

lottery teams• Trends show lottery income has withstood the recession better

than most income streams

• Much broader benefits of lottery players than “just” lottery income – “getting to know your customers”

PTH income2011/12 total income : £6.5m

21%

18%

19%

12%

15%

6%

6% 3%

Retail income

Fundraising

Legacies

NHS Funding

Donations and gifts

Patient Contributions

Lottery income

Investment Income

What does a funding structure like this mean?

• Extremely difficult to plan with any confidence• Unreliable• Volatile – esp legacy income• Potentially adversely affected by external events – e.g. the

weather

• Disproportionate management time & effort for relatively small NHS income

• “Interesting” relationship with the NHS, from whom we receive all our referrals

• Unfair

My ideal characteristics of income streams

• Reliable

• Regular

• Resilient

Testing current funding streamsReliable? Regular? Resilient?

Reliable? Regular? Resilient?Shops 4Fundraising 6Legacies 9NHS funding 6Donations & gifts 9Patient contributions 9Lottery 4Investment income 6

17 16 20 53

Looking forward (1)• NHS reorganisation

– 2013/14 onwards– Clinical Commissioning Groups replacing PCTs– Focus on “end of life care” services – broader than most hospice services

• Palliative Care Funding Review– 2015/16 onwards– Tariff for all end of life providers not just hospices– State responsibility / society responsibility– Pilot sites being set up to test different models / tariffs

Looking forward (2)• Economic challenges

– Current & ongoing issue– CFDG, IoF & PWC report “Managing in a Downturn” (04/12)– “Managing in the new normal – a perfect storm”– 93% say things have got tougher in the last year – and the future doesn’t

look any brighter

Looking forwards – so what?• NHS reorganisation

– Increasingly fragmented commissioners– Partnership working key - many hospices will find themselves in a “subcontractor

role”– Huge opportunities as hospices have many of the solutions to NHS problems –

e.g. keeping people out of hospital

• Palliative Care Funding Review– Increased competition for funds / new competitors– State funding being directed towards community services rather than IP services– Increased confusion by Joe Public as to who funds what

• Economic challenges– Not looking great for the foreseeable future

Testing future funding streamsReliable? Regular? Resilient?

Reliable? Regular? Resilient?Shops 4 Need to diversify to maintain this positionFundraising x x 8 More competition for fundsLegacies 9NHS funding x 7 Currently unclear what changes will meanDonations & gifts 9Patient contributions 9Lottery 4Investment income x 7 Ongoing economic challenges / EU turmoil

18 17 22 57

Change 1 1 2

Concluding remarks• Thank you

• It’s tough out there – for all areas of income• Some are more resilient to external factors than other

• New opportunities emerging – esp with social media, digital

• Don’t forget the added benefits of lottery membership – “supporter journey”

• Keep close to & knowledgeable about the work of your hospice

Thank you

Any questions?