Wales's hospices had a combined revenue of £36 million in 2018 and fundraised around £28 million of this. Statutory funding has flatlined for many years. Children's hospices tell me that, although they operate on a 'buy one, get seven or eight free' basis, they've had flatline statutory funding for 10 years.

Government funding of children's hospices in Wales, as a percentage of its charitable expenditure, is lower than in England and in Scotland. In Wales, children's hospices received 12 per cent of their expenditure from Government funding last year, compared to 21 per cent in England and 53 per cent in Scotland. The UK Government is doubling children's hospice funding to £25 million annually by 2023-24, and the Scottish Government is providing £30 million over five years to support children's hospices there. Wales's children's hospices are calling for action on the recommendations made by the cross-party group report and asking the Welsh Government to fund the study that examines the demands for children's palliative care in Wales and the extent to which that is being met.

Adult hospices tell me that their statutory funding has not changed for a decade and has therefore been dropping in real terms each year. Government funding for adult hospices, as a percentage of expenditure, is lower in Wales than in any other UK nation. In Wales, adult hospices received 28 per cent of Government funding, as a percentage of their expenditure in 2017, compared with 33 per cent in England, 34 per cent in Northern Ireland, and 38 per cent in Scotland.

Now, while most people express a preference to be cared for in their usual place of residence—at home or in their care home—55 per cent of deaths in Wales occur in hospitals. However, many of these may receive some support from a hospice. Given the current pressures in Wales on the number of available hospital beds, hospices provide an opportunity to allow people to access the support they need outside of a hospital environment and according to their own preference. Local health boards should therefore develop close working relationships with hospice providers to allow people to access a holistic package of care, designing services together and commissioning smarter to improve lives and reduce pressure on budgets.

The cross-party group report said that those with dementia, heart failure, and neurological conditions in particular, face a range of barriers to appropriate care and are less likely to be referred than cancer sufferers, when they should be entitled to care at home, in hospices and care homes as well as hospitals. The report said people aged over 85 who live in a care home can struggle to get the right support, something the former Older People's Commissioner for Wales has previously highlighted. The traditional view of a hospice as an in-patient unit where someone might go for the last few weeks of life is too narrow when over 80 per cent of hospice services in Wales are actually delivered out in the community or in people's homes.

The committee report made 11 recommendations for improvement, including that Welsh Government should develop a robust action plan to tackle the gaps in palliative care staffing, prioritising district nurses and community paediatric nurses. Health boards need to ensure there is comprehensive out-of-hours coverage across the whole of Wales. Hospices and palliative care providers should educate colleagues in health and social care about the range of services available—they want to. And the funding formula should be based on current population need, which will require clarification on which measurements will be used in determining need, noting that the end-of-life care board no longer holds the levers and funding has been fully devolved to health boards and that the national clinical lead for palliative and end-of-life care told the cross-party group that, although the board is strongly committed to finding ways to measure outcomes, experience, and the differences made, he was becoming slightly concerned about people saying that it was hard to measure outcomes when they were not trying.

Wales has a rapidly ageing population, with the number of people aged 65 and over projected to increase by 36.6 per cent between 2016 and 2041. Of the 34,000 people who die every year in Wales, 75 per cent need some form of palliative and end-of-life care. As a hospice leader told me this week, 'Needs are growing and growing but no more money is coming in, so at what stage do we start to reduce provision?' They emphasised that hospices' independence is their strength and the reason their communities support them, but added that health boards are getting huge and unequal returns from hospices and therefore have no interest in changing the funding mechanism. It is therefore down to the Welsh Government to make this happen.

Effective collaboration between the NHS and charitable sector is essential if we're to radically improve access to hospice and palliative care for everyone across Wales—I've been saying this here for 15 years—with health boards asking hospices how they can help them deliver more. Let's listen, let's make our hospices deliver everything they possibly can, let's improve lives and let's use that NHS budget a damn sight smarter than we currently are.