Anthony Gibbons, director of business development at Marie Curie Cancer Care, explains that all the charity's hospices have had to put themselves on a business footing, ready to provide data to health authorities to justify their bids for local health budgets.
To do this, the charity has had to invest £300,000 in setting up a computerised patient information system called Pal.Care. This system makes it possible to supply information from each hospice on movements of patients in and out, how long they stay, and what part of the country they come from.
Mr Gibbons says: "This has caused a lot of extra work for the charity - most independent providers such as ourselves are simply not equipped administratively to meet the demands of the purchasing health authorities for such data. On the other hand, installing Pal.Care has enabled us to secure an enormous amount of income we would not otherwise have got."
When the National Health Service underwent its most recent reorganisation, in 1991, a division was introduced between the purchasers (such as health authorities) and the providers (such as hospitals). Purchasers had to buy care from providers to supply a certain level of service. In the same year, in recognition of the need for hospice services, the Department of Health allocated a Hospice Grant to support palliative care services provided by the voluntary sector. This was worth £36m by 1993-94.
Mr Gibbons says the grant was supposed to match funding from the voluntary sector, pound for pound - but in practice the average level of government funding for hospices across the country has been about 36 per cent of service costs.
In March 1994, ringfencing of the Hospice Grant ended. In the current year, an amount of £38m nationally was "identified" as being allocated for hospice service - one way, Mr Gibbons says, of the Department of Health telling purchasers: "You don't have to spend this money on hospice services, but you are expected to do so." But now, from 1 April 1995, the money has been built into the baseline budgets of the health authorities - and the Department of Health is expecting them to investigate how much palliative care they need to buy, and then to buy it.
If health authorities choose to spend their money on other, competing needs - whether that may be community chiropody or heart transplants - then hospices, which in the past have relied heavily on the Hospice Grant, could be in trouble.