Managing our finances wisely and well

An officially outstanding hospice

We manage our finances extremely carefully. In fact, Ashgate is recognised nationally as one the of the UK’s leading hospices for the quality of our care.  

Early in 2025, the Care Quality Commission (CQC) – the organisation that inspects and regulates health and social care services across England – rated Ashgate Outstanding for the second time in a row.  

Not only that, we scored 100% in four out of five categories – including 100% for being well-led. You can read the full report here. 

We’re also one of the most successful hospices in the country when it comes to income generation, raising almost £10 million last year through fundraising and our charity shops.  

Our Sparkle Night Walk is recognised to be one of the best events of its kind in the UK, and our fundraising and retail teams are always innovating to raise as much money as possible. We take the responsibility that comes with your generosity seriously – we know where every pound goes.

Where the money goes

Every pound donated to Ashgate helps provide specialist care for patients and the people important to them at the end of their lives.  

The NHS has a legal duty to make sure everyone has access to end of life care. Here in North Derbyshire, Ashgate Hospice delivers that care on behalf of the NHS to help meet this obligation. Yet the local NHS commissioners – Derby and Derbyshire Integrated Care Board (DDICB) – currently fund only around 50% of the cost of the care they ask us to provide. That leaves us to find the remaining, unjustifiable gap ourselves through fundraising.

To keep services running, we’ve been using our reserves – but this simply isn’t sustainable when demand for our specialist care is growing year on year. In the past three years alone, 18% more people have needed our support, and that number is only expected to rise.

Despite months of negotiations, without extra funding from the local NHS (DDICB) we were left with no choice but to propose job and service cuts. Our consultation process has now concluded. While no services are stopping completely, we have had to make the heartbreaking decision to close beds and make some roles redundant. You can read more about the end of our consultation process on our website.

How we carefully manage our costs

We’ve been managing our costs extremely carefully, and without these controls our spending would have risen much higher, much sooner.

DDICB claim that our costs have risen significantly. In reality, our costs have risen in line with NHS costs. The difference is that when NHS costs rise, those providers – such as GP surgeries, pharmacies or hospitals – are fully funded to meet them. In South Derbyshire, end of life and palliative care providers are fully funded to cover those rising costs. Hospices are not.

Despite delivering essential NHS care on its behalf, Ashgate Hospice receives only around half of what it costs to provide that care – making hospices the only NHS-commissioned service expected to rely on public donations to plug the gap.

Most of the budgeted 2025/26 increase in our costs relates to clinical care, particularly staff salaries. These include a total of £650,000 to cover national insurance and minimum wage rises, as well as cost of living increases. Unlike NHS providers, which receive specific uplifts to cover these costs, we must fund all of this ourselves.

Other budgeted cost pressures in 2025/26 include: 

• Energy costs: Up by £73,000  

• Fundraising costs: Up by £200,000 as we work harder to fill the widening funding gap, for example innovating so our Sparkle Night Walk raises even more each year. These costs have directly raised more for the charity.

• Depreciation: Up by £146,000 because our assets such as beds and equipment are becoming more expensive to replace.

Rising costs and a growing NHS funding gap

The graph below shows how our total care costs have increased since 2017/18 (grey line). DDICB funding (dark blue bars) has never fully covered the cost of the care we provide. The pink bars show the shortfall we have needed to fill through fundraising – and that gap has steadily grown. 

The pandemic made things even tougher, but the generosity of our community and emergency government Covid funding (turquoise bars) helped us through. Some of that extra funding later became part of regular NHS income, yet costs have continued to rise faster than the funding we receive, keeping the gap wide. 

Are Ashgate’s inpatient beds expensive?

No. In fact, our bed costs are comparable to similar hospices and considerably cheaper than the NHS.

In 2023, parliament were presented with NHS bed costs for 20/21, the latest publicly available costs. A non-elective or urgent care bed cost in 20/21 was £901 per night. Using the Bank of England inflation tool, that equates to £1,220 per night in 2025 and it is likely to be more. An Ashgate bed costs £1,018 per night in 2025.

Other ways we save money

We never spend without asking whether we can save. Before making purchases, we always consider community support or discounted charity rates.

Last year, gifts given this way saved over £400,000, and we’ve already saved another £130,000 this year.

We also seek trust and grant support to fund major projects. Our recent Day Services refurbishment and new accessible entrance were both delivered without having to spend any of the charity’s money.

Crucial medical equipment, such as cuddle beds and specialist chairs, is also often funded through grants and charitable trusts.

Growing demand for care 

The graph below shows how our patient numbers have been increasing. More patients mean greater demand on our services, and without a long-term funding solution from the DDICB, the gap between costs and funding was continuing to widen. We were using our reserves to bridge the gap but couldn’t carry on doing this indefinitely as it would have put the long term future of our hospice at risk. In December 2025 we therefore concluded a consultation process to make us sustainable into the future. We are still waiting to hear from DDICB about commissioning requirements for April 2026 onwards and hope to meet with them early in the New Year.

Our Board of Trustees and good governance

Ashgate is governed by a Board of Trustees who generously volunteer their time to support our charity. They bring specialist skills and experience across nursing, accounting, business and more. You can find out more about who they are here.

Our Trustees provide independent oversight, scrutinising leadership decisions and ensuring we meet our legal responsibilities and use charitable funds wisely and responsibly, including on decisions such as Leadership Team salaries.

We are an independent charity and while we desperately need more NHS funding, our Trustees are also clear that we need to retain our independence and the outstanding quality of our care, which is what matters so much to our community.

Every year we publish our annual reports and accounts which are independently audited.

Our commitment to strong governance was recognised in our recent Care Quality Commission (CQC) inspection, where Ashgate was rated Outstanding. We were particularly proud to receive 100% for being well led, reflecting the strength of our leadership and governance during an unannounced inspection in December 2024. You can read the CQC report here.

What has the Government done so far?

We did receive a total of £844,000 from the government’s hospice fund (across 2024/25 and 2025/26), but this can only be used for buildings and equipment, not for delivering care or paying the teams who provide it. For example, it helped us pay for improvements to our day hospice, making the environment more welcoming to everyone, including younger patients. It is also being used to pay for things like solar panels to reduce our energy bills.

Derby and Derbyshire Integrated Care Board (DDICB) negotiations

Because we manage our finances so closely – knowing exactly where every pound is spent and what our costs are – our Board of Trustees and Leadership Team reluctantly agreed that we had no choice but to announce proposed service changes and job cuts in 2025. This was due to the significant – and growing – shortfall in funding we receive from the local NHS.

We have been in discussion with DDICB for many months about our funding challenges. We had hoped to receive interim funding to allow talks to continue without the need for consultation with our teams, but at the last minute we were told that this short term funding was no longer available.

Instead, in October, DDICB offered to spend up to £100,000 for an independent consultant to review Ashgate’s service costs and funding arrangements, with the possibility that a small part of that sum might be used to mitigate our immediate financial position. With reserves already below target and having delayed any announcement in the hope of receiving timely funding, our Board agreed we had no alternative but to begin consultation with our teams.

We have provided DDICB with extensive, detailed financial information including at and following a meeting at Ashgate with their Chief Finance Officer at the start of December. DDICB have confirmed that they are currently reviewing this information, and we hope to hear from them as soon as possible on next steps. 

We are very grateful for the Minister of State for Care’s offer to help facilitate discussions between Ashgate and DDICB, and for the support of Derbyshire’s MPs for helping to arrange this.

The facts remain the same: despite the incredible generosity of our community, we need the local NHS to fund us fairly and more in line with NHS and Hospice UK guidelines.

We have also welcomed a firm and clear commitment by Minister of State for Care, Stephen Kinnock, for plans for palliative care and end of life care modern service framework (MSF) to improve access, quality and sustainability in the sector.

Chief Executive Barbara-Anne Walker says: “The Minister of State clearly recognises what we have been saying for months now – there is a postcode lottery affecting end of life care and it is reflected here in Derbyshire. There is a pressing need to make sure that everyone who needs specialist palliative and end of life care can access it, wherever they live.

“In South Derbyshire, specialist end of life care is fully funded by the NHS, where it is provided at University Hospitals Derby and Burton. In North Derbyshire, where that care is provided by Ashgate, just 50% of our funding comes from the local NHS. That can’t be right.”

If you agree, please stand with Ashgate now. Write to your MP or DDICB and support our Act Now for Ashgate campaign for fair funding for our hospice and our local community.