Ensuring dignified, sustainable, and equitable end-of-life care in Wales

Dr Huw Evans

As reported in Nation.Cymru recently, the Welsh Government has announced ‘stabilising’ funding for palliative and end-of-life care in Wales – otherwise known as hospice care – together with setting up the foundation to put hospice care delivery across Wales on a sustainable and equitable basis.

But this has been left for the next Welsh government to take forward.

According to polling predictions, Welsh Labour will not be forming that government and so it is important that whoever takes over completes the task.

Hospice care

Hospice care focuses on improving the quality of life for people with incurable conditions. It aims to be holistic and values dignity, respect, and personal wishes, addressing medical, emotional, social, practical, psychological, and spiritual needs, as well as those of families and carers.

While the term ‘hospice’ often refers to a dedicated residential home providing palliative and end-of-life care such as the Marie Curie Hospice in Penarth, hospice care can be provided in any setting. For example, City Hospice in Cardiff provides its hospice care wholly in the community.

But although death and dying affect us all, hospice care has historically been insufficiently discussed. This has led to it not getting the priority it deserves, Recent developments suggests this may be changing.

This change may in part be down to the wide public debate generated by the Terminally Ill Adults (End of Life) Bill which, if passed, will allow assisted dying in limited circumstances for people with a terminal condition. By definition, those people will have hospice care needs.

Current hospice care delivery in Wales

According to Liz Booyse, chair of Hospices Cymru, an average 30% of hospice care funding was from the Welsh Government and the NHS, while the remaining 70% was from charitable donations. The significant reliance on charitable donations, arguably, shows an historic low priority towards hospice care in health and social care delivery.

Hospice care in Wales is under financial strain due to rising costs and funding issues, with nine out of 14 hospices facing deficits for 2025-26, with one closed, and another temporarily shut. In March 2025 Marie Curie Wales reported that hospice care in Wales was at ‘breaking point’, leaving many without needed support. The current system is unlikely to meet future needs as current demand is rising: 37,000 people in Wales may require such care annually by the 2040s.

Marie Curie Wales listed ten ‘actions’ for the incoming Welsh government in 2026 to follow to address this position

These actions included: sustainable funding for hospice care services throughout Wales; developing an adequate hospice care workforce to meet hospice care needs; ensuring equal access to high-quality hospice care across Wales for all people; and ensuring that people with terminal illnesses are discharged from hospital when ready to leave with proper support in their preferred destination, whether at home or somewhere else.

As to hospital discharge, according to Madame Curie Wales an average of 1,578 people in 2024 were in hospital unnecessarily at any one time because of delayed discharge, and a significant number of these are likely to have needed hospice care.

Delayed discharge was mainly due to assessment issues, particularly delays in social care assessments, illustrating the connectedness between health and social care. If the social care system lacks capacity, this delays the delivery of hospice care that a person may need; and there can be a corresponding denial of dignity for that person.  Health care delivery is also delayed until discharge occurs, at which point capacity becomes available.

Welsh Government initiative

It appears the Welsh Government listened as on 25 March 2026 the it announced a £4.3 million support package for hospice care in Wales to help ‘stabilise… hospice services across Wales’ to allow service providers ‘to maintain essential services, protect staffing capacity and ensure continuity of high-quality care’. Therefore, this wasn’t an investment package; it was about keeping the hospice boat afloat. The support is to be welcomed but underpins the need for a more sustainable system of hospice care in Wales.

In fairness to the Welsh Government, that position was acknowledged and accompanying the financial support there was new guidance about achieving sustainable and equitable commissioning of hospice care across Wales .

The need for this arose due to acknowledged current variations within Wales in hospice care access, funding approaches and long-term sustainability, reflecting what Madam Curie Wales had reported.

The guidance emphasised that this was a starting point only and more work was needed including moving ‘towards a more sustainable national commissioning from next year’. However, as mentioned, it seems this will not be taken forward by Welsh Labour because it will not form the next Welsh government. However, other parties in their public utterances seem to support Welsh Labour in moving in that direction.

From the cradle to the grave

The NHS promotes health care access from the cradle to the grave’, with hospice care addressing the final stage. Hospice care delivery though is not restricted to the NHS as it includes others such as local authorities, the third sector, and the community. High-quality hospice care should be available to all those that need it.

The recent action by the Welsh government does lay a sound foundation on which to build. Hopefully, whoever has the reins of power will take this forward in the way envisaged leading to sustainable high- quality hospice care across Wales.

But it needs more than fine words and stated intentions. And for that to follow, there must be the political will and related funding.