title: Commissioning of specialist palliative care services in England.
abstract: OBJECTIVE
  Some failures in end-of-life care have been attributed to inconsistent provision of palliative care across England. We aimed to explore the variation in commissioning of services by Clinical Commissioning Groups (CCGs) using a data collection exercise.
  
  
  METHODS
  We sent a Freedom of Information request in the form of an open questionnaire to all 209 CCGs in England to assess their commissioning of palliative and end-of-life care services, mainly focused on the provision of specialist palliative care services.
  
  
  RESULTS
  29 CCGs provided information about the number of patients with some form of palliative care needs in their population. For specialist palliative care services, CCGs allocated budgets ranging from £51.83 to £2329.19 per patient per annum. 163 CCGs (77.90%) currently commission 7-day admission to their specialist palliative care beds. 82.84% of CCGs commission 7-day specialist palliative care services in patients' own homes and out-of-hours services rely heavily on hospice provision. 64 CCGs (31.37%) commission pain control teams, the majority of whom only operate in regular working hours. 68.14% of CCGs reported commissioning palliative care education of any sort for healthcare professionals and 44.85% of CCGs had no plans to update or review their palliative care services.
  
  
  CONCLUSIONS
  The most important finding from this exercise is that the information CCGs hold about their population and services is not standardised. However, information based on data that are more objective, for example, population and total budget for palliative care, demonstrate wide variations in commissioning.
authors.affiliation: House of Lords, London, UK.
authors.forename: Harriet
authors.initials: H
authors.lastname: Lancaster
authors.affiliation: House of Lords, London, UK.
authors.forename: Ilora
authors.initials: I
authors.lastname: Finlay
authors.affiliation: House of Lords, London, UK.
authors.forename: Maxwell
authors.initials: M
authors.lastname: Downman
authors.affiliation: House of Lords, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Dumas
mesh_terms: D004739:England; D006288:Health Planning Organizations / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration; D017051:Hospice Care / Q000458:organization & administration; D006801:Humans; D020380:Needs Assessment; D010166:Palliative Care / Q000458:organization & administration*; D013038:Specialization; D013727:Terminal Care / Q000458:organization & administration*
keywords: Communication; Education and training; Home care; Hospice care; Hospital care; Service evaluation