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Hospice inpatient care models: cross-sectional inequality survey
  1. Suzanne Tween1,
  2. Roger William Smith2,
  3. Charlotte Chamberlain3 and
  4. Jane Gibbins4
  1. 1Department of Primary Care, Royal Cornwall Hospitals NHS Trust, Truro, UK
  2. 2Department of Palliative and Supportive Care, Somerset NHS Foundation Trust, Taunton, UK
  3. 3Department of Supportive and Palliative Care, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  4. 4Department of Palliative Medicine, Cornwall Partnership NHS Foundation Trust, Bodmin, UK
  1. Correspondence to Dr Suzanne Tween, Department of Primary Care, Royal Cornwall Hospitals NHS Trust, Truro, TR1 3LJ, UK; suzanne.tween{at}


Objectives Hospices provide a range of services including inpatient units (IPUs) and care in people’s homes. 40 000–50 000 patients use IPUs in the UK per year. Little published data exist on IPU models. This paper explores the structure and funding of IPU across the Southwest (SW) of England (population 5.6 million), alongside impact of COVID-19.

Methods An electronic survey of all 13 IPUs. Data collated, tabulated and compared with national commissioning guidance.

Results A 92% survey response rate revealed large variation in bed availability per 250 000 of SW population: 2.5–18.2. Referrals and admissions per IPU bed per year ranged from 16 to 38.2 (or 39–127 per 100 000 population) and 21.7 (mean), respectively. There was significant workforce variability: 1.3–12.7 nurses per 7.5 hospice beds, 1.2–7.2 consultants per 20 hospice beds, varying multidisciplinary team members with many unfilled posts. National Health Service (NHS) funding ranged from 10% to 75% of total costs. During COVID-19, 4 of 12 hospices reduced bed capacity, while half described increased integration with other teams outside of the hospice.

Conclusion There is significant regional variability suggesting inequality in hospice bed availability per 250 000 population. There is also considerable variability in workforce, alongside the proportion of NHS funding. Such variability implies little is known about the optimal IPU model. This provides new meaningful information about the structure and funding of hospices, with further research needed to consider these differences on the impact on patient and family experiences and outcomes. The sustainability and opportunities of integration and collaboration across care settings are also paramount.

  • COVID-19
  • Hospice care
  • Palliative Care
  • Patient Care Team
  • Service evaluation
  • Communication

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  • Contributors JG presented the idea. RWS and ST designed the survey and organised and conducted data collection. RWS, ST, CC and JG contributed to data analysis and evaluation of results. ST drafted the initial manuscript with assistance from JG. Critical revision of the manuscript was performed by ST, RWS, CC and JG. The final version of the manuscript was written and approved by RWS, ST, CC and JG.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests The authors have interest in sustainable funding models and well-functioning SPCTs, where their income is dependent on NHS and/or charitable funding.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.