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The Independent Expert Panel (IEP), commissioned by the Health and Social Care Committee, has produced a report on England’s palliative and end of life care services. 

Published 28 November, the report follows an evaluation of palliative care services which began in March 2025. 

The evaluation was carried out under five broad headings. The IEP’s findings are summarised below. 

• Read the report (HTML)
• Health and Social Care Committee

Commissioning of palliative and end of life care services 

The IEP found that efforts to commission services are impacted by complexities and variabilities, leading to differences in quality around the country. This variability also arises from a lack of a nation-wide framework for how Integrated Care Boards (ICBs) should commission palliative care services. 

ICBs were often found to not be equipped well enough to understand the palliative and end of life care needs of their local populations, in some cases due a lack of access to data. 

Because palliative care is often not prioritised in local areas, it faces insufficient funding from ICBs, which themselves face persistent funding pressures. 

Delivery of palliative and end of life care services 

The IEP found evidence of services under significant strain across all types of setting that it examined. It also found some examples of good practice, such as effective partnerships between hospices and GPs. 

The experts heard that patients and their next of kin struggle to navigate a complex and fragmented system for palliative and end of life care. The system lacks a single point of access and communication. 

Service users are also rarely given the opportunity to plan ahead effectively. Patients were too often not identified early enough and offered advice, and when conversations did take place they were not sufficiently meaningful. The Panel also identified that some patients and families struggle to engage with advance planning discussions and the prospect of dying. 

Furthermore, bereavement services were found to be valuable but frequently inaccessible due to patchy levels of provision across the country and a high dependence on voluntary organisations. 

Shifting to the Community 

Following the Covid pandemic there has been an increase in the number of people dying at home, in care homes and in hospices, while fewer are dying in hospital. Currently just over one quarter of patients die at home. 

The Government’s overarching strategy for the NHS, for more services to be delivered in neighbourhood or community settings rather than in hospitals, applies strongly to palliative and end of life care.  

However, progress with undertaking this shift has been hindered due to current funding approaches and inadequacies in local social care services. Spending on primary and community health care accounts for 11% of health expenditure for people in their last year of life, while hospitals receive 81% of the spending. Moreover, 22% of public expenditure per person at the end of life is on social care, compared to over 50% of total expenditure on healthcare. 

Workforce, education and skills 

The NHS workforce was found to be ill-equipped to meet the needs of people at the end of life because of insufficient provision of education and training. 

Furthermore, there are shortages of staff in the specialist palliative workforce, as well as additional shortages in the generalist workforce, such as district nurses. 

Children and young people’s palliative and end of life services, as well as social care services, are also facing serious shortages of trained professionals. 

Inequalities and inequities 

The IEP received evidence of systemic inequality throughout the country, both in terms of the quality of services available in different parts of the country, but also inequalities experienced by underserved or marginalised communities. 

The IEP report was produced before the Government announced on 24 November that it intends to develop a Palliative Care and End of Life Care Modern Service Framework for England, with a planned publication date of Spring 2026. 

The Health and Social Care Committee plans to hold an evidence session in the New Year with the Minister for Social Care, Stephen Kinnock, to discuss the findings of the IEP’s report.