Jackie Stone says hospices now face a perfect storm
As the chief executive of a hospice in Scotland, I have the privilege of witnessing the compassionate work of our teams each day as they provide specialist care to patients nearing the end of their lives and support to their families.
Hospice care, however, is not only about compassion and dedication—it’s about ensuring these services remain sustainable and accessible to everyone who needs them, regardless of their financial means.
In recent years, maintaining this sustainability has become increasingly difficult, and it’s time we address the funding challenges that are threatening the future of hospice care in Scotland.
Each year, 14 independent adult hospices and two children’s hospices work tirelessly to deliver nationwide care to around 21,000 patients and their families, supported by a dedicated workforce of approximately 2,000 staff and countless volunteers.
Hospices provide over 72,000 home visits, 51,000 days of inpatient care, and 23,000 outpatient appointments annually. In fact, nearly 60% of this care is delivered in people’s homes, reflecting a deeply rooted commitment to honouring the wishes of patients and families.
To make this possible, most hospices continue to rely heavily on charitable donations, with only a portion of their funding coming from government sources. This reliance on charitable giving means we are particularly vulnerable to economic fluctuations and must divert energy from care to fundraising activities, just to stay afloat. This isn’t the most efficient model, nor is it a fair one.
Hospice care is integral to Scotland’s healthcare system and should be securely funded, especially as costs continue to rise.
Recent increases in National Insurance (NI) contributions and the substantial rise in salaries across the health and social care sector have compounded these pressures on hospice finances. This year alone, salaries have risen 5.5% for NHS clinical and support staff and 10.5% for consultant doctors. While these increases are aimed at supporting healthcare workers—a goal we fully support—they have significantly impacted hospices, which now face increased payroll and operational costs without additional government support.
Hospices now face a perfect storm: donations are under pressure as the cost of living rises, staffing costs are increasing, and the need for hospice care is growing with our aging population - demand for care in Scotland is set to increase 20% by 2040. This financial strain not only limits our capacity to deliver care but also affects our ability to attract and retain the skilled and dedicated professionals who are essential to our mission. As hospices, we can no longer absorb these rising costs alone without compromising the quality of care.
The Scottish Government recognises hospice care as a core element of palliative care in our country. However, the current funding model does not reflect this commitment. We need a fairer and more sustainable funding model, one that secures hospice care for the future, does not vary depending on postcode, and ensures that those in need can access high-quality, end-of-life support without delays or barriers.
A new funding approach, ideally with increased direct government contributions, would be a lifeline, enabling us to confidently plan. The funding should consider recurring support for rising National Insurance contributions and rising operational costs so that hospices can continue to meet the complex needs of our communities.
Finally, we must factor in the wider social value hospices provide, relieving pressure on NHS hospitals and reducing the need for costly acute care interventions. It is essential that the Scottish Government funds pay parity between NHS and hospice staff so that we do not face recruitment challenges or run the risk of undermining the workforce we depend on.
The time has come for Scotland to fully acknowledge that end-of-life care is a vital component of the healthcare system, not a charitable extra. With fairer funding, we can secure hospice services across Scotland, ensuring that every individual can experience a dignified and supported end to life. Inaction risks creating inequality in end-of-life care, which would be a tragedy for Scotland and a disservice to the legacy of compassionate care that defines the modern hospice movement.
It is not an exaggeration to say that the future of hospice care in Scotland is at a critical juncture. A fairer funding model is not just a financial necessity - it is a moral imperative. Let’s work together with our government and communities to build a more sustainable future for hospice care in Scotland, one where everyone receives the care they deserve in their final days, without fear of financial barriers or service limitations.
In a world where compassion and care can be as powerful as medical treatments, hospice care stands as a beacon of support for individuals and families facing the profound challenges of palliative and end-of-life care. As a society, we must recognise that investing in hospice care is a firm commitment to dignity, compassion and humanity.
In this time of rising costs and growing need, fairer funding is the only path forward if we are to safeguard this essential service for the generations to come.
Jackie Stone is chief executive of St Columba’s Hospice Care, Edinburgh.
