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NHS England publishes the long-awaited currencies for palliative care

Author: Jonathan Ellis
31 March 2017

Jonathan Ellis, Director of Policy and Advocacy at Hospice UK, discusses the development of the new currencies for palliative care, and how they will affect the future of funding for hospices.

The long-awaited final version of the palliative care currencies have been published by NHS England. 

While the currencies won’t change the world of hospice funding overnight, they are an important step forward in tackling the funding inequity for hospice and palliative care in England.

Alongside the currencies, NHS England has also published a summary of the quantitative and qualitative testing that has been undertaken, and guidance on using the currencies for both the adult and children’s services. 

The currencies are now available for use from April 2017, and could prove to be a very useful resource to hospices in their discussions with clinical commissioning groups (CCGs). 

The world has changed a lot since 2011

Work on the new funding approach for palliative care began after the 2010 General Election, when the Coalition Government kick-started a review of palliative care funding which made recommendations for the future.  Those recommendations have gone on to inform the development of the palliative care currencies.

The health care world is very different now compared to 2011. At that time, we still had a centrally managed health care system in England, and the traditional Payment by Results system of incentivised activity was still the direction of travel for commissioning many health services and, for many, the aspiration for palliative care funding. 

Today, we have a heavily devolved care system, and an NHS that takes a more sophisticated approach to funding and commissioning care than was the case 6 years ago, with a much stronger emphasis on quality, outcomes and impact, rather than just on activity.    It is within this context that the new currencies land within the system. 

They are not a panacea…

Of course, they are not a panacea for all of the funding inequalities that exist in hospice and palliative care. 

We know that statutory funding for hospice care is coming under increasing pressure, and most hospices can expect, at best, frozen NHS funding for the coming financial year.  And there are continuing and deepening inequalities in the level of funding that hospices receive, between different areas, and between adult and children’s services. 

As the need for palliative care continues to grow, and as more people live with and die with increasingly complex needs, the need for the NHS to address these inequalities and to invest in improving palliative and end of life care continues to loom large. 

…but they will be very useful

In time, however, the new palliative care currencies could help.  They are a potentially helpful addition to the commissioning toolbox that CCGs and hospices can use to better understand the need that exists, and to build evidence for the case for local investment. 

Firstly, currencies help describe similar types of clinical care which are generally resourced and costed in a similar way, and as a result, the currency model can help CCGs understand what palliative care is and what activities providers undertake to meet local needs.  It helps to create a common understanding between the NHS and charitable hospices, community services and hospitals about palliative care.

Secondly, the currencies provide a framework for the conversations that hospices will have with commissioners about assessing, planning and funding care within their local communities.  While the language of currencies may be new to the hospice movement, it is language that the NHS is very familiar with. 

So, how might currencies affect funding?

Helping commissioners to understand more about palliative care and the complexity of needs that hospices are meeting locally could be helpful in building a case for investment locally. Being able to clearly demonstrate the nature and level of needs that people using hospice services have will strengthen the case for such investment. 

NHS England is not prescriptive about the payment approaches that CCGs should adopt.  The guidance document helpfully summarises the different options available to commissioners, although most hospices are effectively funded on a variant of a block contract basis, whether or not that might be wrapped up in an NHS contract.  As the currencies become more widely used, they will undoubtedly start to form a more robust evidence base for local funding decisions.

What has the hospice experience been so far?

Hospices have been involved in the development of the currencies from the very outset, and Hospice UK has been working closely with NHS England and our charitable partners on this work since 2011. 

The currencies have been through rigorous testing and piloting, and several hospices have been involved in that work.  The guidance document includes case studies from St Luke’s Hospice in Sheffield, and Keech Hospice Care. 

Keech Hospice also gave a presentation about their experiences of collecting the data needed for the currencies at the 2016 Hospice UK conference.  You can access the slides from their presentation on the Hospice UK website.

A step in the right direction, but a long way to go

While the currencies are undoubtedly a step in the right direction, there is a long way to go to secure the fairness, equity and transparency in NHS funding for hospice care, and Hospice UK will continue to push for action by Government and the NHS to make improvements in the funding and commissioning of hospice care. 

We want to hear from you

In the coming year, Hospice UK will continue to closely monitor NHS funding for hospice care, and to understand how the currencies are being used by hospices and the NHS.  Later in the spring, we will be circulating a slimmed-down version of our annual survey of NHS funding for hospice care which provides an important snapshot of trends in NHS funding.

We would also like to hear about your experiences of the currencies in the coming months.  How are your local CCGs using them?  Are they helpful to you in your discussions with CCGs?  How could they be improved?  Please share your experiences by emailing policy@hospiceuk.org

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