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