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Commissioning of specialist palliative care services in England
  1. Harriet Lancaster,
  2. Ilora Finlay,
  3. Maxwell Downman and
  4. James Dumas
  1. House of Lords, London, UK
  1. Correspondence to Professor Baroness Ilora Finlay, House of Lords, London SW1A 0PW, UK; finlayi{at}


Objectives Some failures in end-of-life care have been attributed to inconsistent provision of palliative care across England. We aimed to explore the variation in commissioning of services by Clinical Commissioning Groups (CCGs) using a data collection exercise.

Methods We sent a Freedom of Information request in the form of an open questionnaire to all 209 CCGs in England to assess their commissioning of palliative and end-of-life care services, mainly focused on the provision of specialist palliative care services.

Results 29 CCGs provided information about the number of patients with some form of palliative care needs in their population. For specialist palliative care services, CCGs allocated budgets ranging from £51.83 to £2329.19 per patient per annum. 163 CCGs (77.90%) currently commission 7-day admission to their specialist palliative care beds. 82.84% of CCGs commission 7-day specialist palliative care services in patients' own homes and out-of-hours services rely heavily on hospice provision. 64 CCGs (31.37%) commission pain control teams, the majority of whom only operate in regular working hours. 68.14% of CCGs reported commissioning palliative care education of any sort for healthcare professionals and 44.85% of CCGs had no plans to update or review their palliative care services.

Conclusions The most important finding from this exercise is that the information CCGs hold about their population and services is not standardised. However, information based on data that are more objective, for example, population and total budget for palliative care, demonstrate wide variations in commissioning.

  • Communication
  • Education and training
  • Hospice care
  • Hospital care
  • Home care
  • Service evaluation
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  • Contributors MD and BIF designed the FOI request and study. MD and JD communicated with all CCGs and undertook preliminary data entry. HL entered data, checked all data entry for consistency, analysed the data and led writing of the paper at all stages. BIF discussed the possibility of piloting, oversaw the process, checked calculations based on the data and edited all drafts of the paper.

  • Funding The FOI request incurred no cost. All funding for analysis and writing was provided by IF.

  • Competing interests BIF wrote and introduced the Private Members' Bill the Access to Palliative Care Bill to the House of Lords in 2015–2016. HL is currently employed as Parliamentary Researcher to BIF, MD and JD have previously been employed as Parliamentary Researchers to BIF.

  • Ethics approval As the Freedom of Information Act was used to request data and no person identifiable data were sought, there were no aspects to this survey requiring ethics committee approval. All CCGs were notified of our plan to publish the study findings, and all data have been reported anonymously in our analysis.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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