Accounting for hospices : Palliative care at risk

Abstract

This article is concerned with the provision of palliative care services in England by voluntary hospices. The literature on voluntary hospices is fragmented and scattered within and across academic and practitioner discourses. Our argument is that we can consolidate this literature into a descriptive business model. This reveals how charitable income streams donated to voluntary hospices are significant relative to government funding. However, this charitable income is uncertain and volatile. Hospices operate with significant balance sheet reserves as a hedge against uncertainty but these funds, invested in capital markets, recycle uncertainty. Rubbing up against uncertainty, embedded in the hospice business model, is the fact that demand for palliative care will certainly increase. The population is expanding and we are generally living longer and this is set to inflate demand for hospice palliative care. Imaginative government policies, informed by the descriptive business model of hospice palliative care, are required if choice and demand for end of life palliative care are to be satisfied. Policies could include government: underwriting a higher share of hospice income, matching funds for an emergency contingency reserve, inventing “hospice bonds” with a coupon clip above treasury rate to boost income whilst also preserving development funds set aside. Without change, the capacity to deliver patient choice and hospice palliative care going forward is at risk.