1. Hospice Lotteries Association Annual Conference Funding Hospice Care : What does the future look like? Sarah Brocklebank Chief Executive 12 th September 2012

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

4. 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

5. 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

6. 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”

7. PTH income

8. 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

9. My ideal characteristics of income streams Reliable Regular Resilient

10. Testing current funding streams Reliable? Regular? Resilient?

11. 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

12. 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

13. 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

14. Testing future funding streams Reliable? Regular? Resilient?

15. 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

16. Thank you Any questions?