28th July 2025
An open letter from Trevor Johnson, Chief Executive at Acorns Children’s Hospice.
The announcement of Government capital grants for adult and children’s hospices is welcome and valuable. These funds will undoubtedly help improve facilities, upgrade equipment, and enhance the environments where care is delivered.
However, there’s a reality that needs addressing: these grants don’t pay for a single minute of what truly matters, the compassion and love that defines hospice care.
Capital grants focus on the tangible in modern equipment and updated facilities. These improvements are genuinely valuable and needed. A hospice with outdated facilities or inadequate equipment cannot provide the best medical or supportive environment that children and families deserve when facing the darkest times in their lives.
The heart of hospice care isn’t found in the buildings or the equipment. It’s in the hands of the people who deliver it – our nurses who adjust medication at 3am, the gentle voice that comforts a child and the support that guides families through impossible moments. The care teams who provide the specialised palliative care that makes our hospices unique remain unfunded by capital grants.
Behind the welcome news of facility improvements lies a deeper funding crisis. Hospices across the country are struggling to maintain staff levels and provide vital care, not because they lack commitment, but because they lack sustainable funding for essential roles. The specialised training required for palliative and end-of-life care, combined with the emotional demands of the work, means hospices need competitive salaries to attract and retain care staff.
This challenge becomes even more acute in children’s hospices, where nursing requirements are more complex. Paediatric palliative care requires specialised training in child development, family dynamics, sibling support, and the consideration of the unique medical needs of children with life limiting conditions. These highly skilled professionals are even scarcer than adult hospice nurses, yet children’s hospices face the same capital-focused funding approach that fails to address such critical staffing needs.
Capital grants create better spaces for care but don’t address the fundamental question: who will provide that care, and how will it be funded?
A new patient room funded by a capital grant costs money to build and equip. However, the nursing care required to make that room meaningful in providing 24-hour support, specialised pain management and symptom control, family support, and end-of-life expertise costs significantly more and requires ongoing, reliable funding.
In children’s hospices, these economics become even more challenging. Children’s hospices often need higher staff-to-patient ratios, with nurses trained not only in paediatric palliative care but also in supporting entire families through unimaginable circumstances. They must be equipped to comfort a child, support exhausted parents, and help siblings understand what’s happening – all while managing complex medical conditions that vary dramatically from adult care.
This isn’t to diminish the value of capital improvements. Patients deserve quality environments, and families need comfortable spaces during difficult times. However, even the most sophisticated facility becomes merely an expensive shell without adequate nursing staff to breathe life into it.
The hospice sector needs a balanced approach to funding that recognises both infrastructure and operational realities. While celebrating capital grants, we must simultaneously advocate for sustainable core funding: regular, predictable funding streams that allow hospices to maintain appropriate nurse-to-patient ratios and competitive salaries. As well as long-term operational support: understanding that the ongoing costs of compassionate care far exceed the one-time costs of facility improvements.
There’s a risk that capital grants, while well-intentioned, may inadvertently mask the more pressing operational funding crisis. Ribbon-cutting ceremonies at new facilities make for positive headlines, but the real measure of hospice success happens in quiet moments between care teams and families that require adequate staffing levels to achieve.
This disparity is particularly stark in children’s hospices. The most modern hospice facility cannot compensate for understaffing or the inability to retain experienced staff.
The Government’s capital grant program represents an important step forward, and the hospice sector is genuinely grateful for this investment. However, it must be part of a broader commitment to hospice care that includes sustainable operational funding.
As we welcome these capital improvements, let’s not lose sight of what makes hospice care truly exceptional: the skilled, compassionate care teams that no grant for bricks and mortar can provide.
Our teams support families in their darkest hours, providing medical care, emotional support, and practical guidance in a situation that otherwise would be unbearable. As a parent said to me earlier this week: “I have positive memories of my daughter because of the hospice.”
The question isn’t whether capital grants are valuable. They are. The question is whether we’ll complement these physical improvements with the operational funding needed to ensure they’re staffed by the people who make hospice care meaningful.
Until that happens, we’re building impressive shells around an increasingly fragile core, leaving the most vulnerable people, especially children, without the specialised care they desperately need.
Acorns is now calling on the Government to secure vital funding for children’s hospice care across England.