'I lie awake wondering how we fund our hospice'

Rachel McMillan says core hospice services need 100% NHS funding instead of the current model

The boss of a large hospice has told how its financial problems are giving her sleepless nights.

Rachel McMillan, chief executive of Moya Cole Hospice in Manchester, said it needed £20,000 daily to run it. "It keeps me awake at night - every day it is always a challenge."

The NHS pays for about a quarter to a third of hospices' running costs but Hospice UK says financial pressures mean one in five beds are unused. Ms McMillan added: "Core services like in-patient beds, out-patients, or work in the community need 100% funding - we can do the rest."

The government said: "We are exploring how we can improve the access, quality and sustainability of all-age palliative care and end-of-life care."

Hospices are run by charities, raising a large portion of their income from donations and private fundraising. They depend on the rest from the NHS, and many working in the sector say funding has not kept pace with costs, such as employer national insurance.

"The funding model is archaic, it's not fit for purpose," Ms McMillan said.

"We have to raise £20,000 every single day of the year just to keep the doors open."

She told BBC Breakfast that two years ago the hospice took the "tough" decision to reduce the number of beds by 20% to 36 beds.

'Deserve a good death'

Ms McMillan said the crisis facing the hospice movement was "heartbreaking".

She added: "We're not asking for a lot. People deserve a good death - the NHS was set up for the cradle to grave. We're missing that end bit, we only have one chance to get it right."

Senior nurse and ward manager Lindsey Pinney spelled out the stark choices facing the hospice with fewer resources.

She said: "We will move heaven and earth to get people in but we haven't got infinite resources, we haven't got infinite staff.

"Sometimes we have to tell people 'not today but tomorrow' and that can be very difficult."

The Department of Health and Social Care spokesperson said the government had already invested £100m to improve hospice facilities in England and had committed £80m for children's and young people's hospices over three years.

But the BBC's health editor Hugh Pym says the £100m is specifically for capital spending on improving buildings and facilities rather than for day to day running costs.

Charlie King, director of external affairs at Hospice UK, said: "The financial situation facing hospices is untenable, with even more beds out of use this year than last year.

"Hospices desperately want to reach everyone who needs them, but financial pressure is holding them back."