A third of all hospices in England are on the brink of making redundancies and cutting back services for end of life care as the coronavirus pandemic continues to plunge the sector deeper into a funding crisis.
ITV News has learned that 56 of England's 169 hospices are at financial risk and are being forced to contemplate service cuts and redundancies, just as the sector prepares for a second wave of Covid-19.
Hospice UK, the national charity for hospices and palliative care, is working with NHS England to identify the most cash-strapped providers of end-of-life care to see of local clinical commissioning groups (CCGs) can step in to help.
“Hospices still need to pay their nurses, but we’re seeing a third of hospices in England talking about making redundancies and cutting services and they will be permanent - which is catastrophic," said Hospice UK.
“Hospices have been a vital part of the Covid response and they’re going to be desperately needed over winter.”
Marie Cure, the largest provider of end of life care in the UK, told ITV News more dying people won’t get the support they need this winter as hospices brace for a surge in demand.
The charity said last winter alone over 240,000 people died, with (75%) of these estimated to have needed some form of palliative care, and it is concerned the death toll could be much worse this winter.
Marie Curie's Medical Director Dr Sarah Holmes said she fears "it could be the worst winter ever" but the they "can’t sustain the level of care needed in the longer term without more sustainable funding.”
For smaller hospices, the challenge is even greater.
Dr Sarah Holmes: "It's going to be incredibly tough, it's a really scary prospect..."
Katherine House hospice in Stafford confirmed 200 staff will be consulted on redundancies and four of its charity shops will close as they announced palliative care services will be cut unless it raises £1m by January.
Hospice UK told ITV News Katherine House was "the first of many" and cuts across the sector were now likely.
"The four months of government support has been essential in keeping hospices fully functioning through to the end of August, and we are hugely grateful," said Tracey Bleakley, Chief Executive of Hospice UK.
"However, it is sadly the case that some hospices have no option but to consider redundancies and reducing support until they have some certainty."
The cuts could come at a time when hospices are most needed to deal with a second wave of coronavirus.
In April, at the height of the first wave, we revealed hospices were caring for 24,000 people a day - three times more than the same period in 2019.
The government gave hospices £200m to help get through the Covid-19 crisis after ITV News found hospices had lost £70m in the first month of the pandemic as fundraising all but stopped following the national lockdown.
The average adults hospice in England receives 32% of its funding from government health budgets, for children's hospices it is 17%.
Resident Alison Buckley on why she 'doesn't know where she'd be' without her hospice
The majority of funding is received through fundraising, and despite charity shops re-opening, large-scale fundraising events such as the London Marathon are not taking place.
Marie Curie said the sector was "already stretched to its limits even before the pandemic" and it is long overdue for governments to step up and properly fund end of life care.
Marie Curie’s Medical Director and Consultant in Palliative Care, Dr Sarah Holmes, said: “It’s all coming this winter, which we fear could be the worst winter ever.
"The patients we’re seeing out in the community at the moment are at risk. In some instances, their support networks quite literally disappeared overnight at the start of lockdown.
"They may have missed out on treatment over the last few months and they’re frail and vulnerable; they are going to be more prone to flu and will suffer the consequences of a system struggling to deal with Covid-19 and other winter pressures.
“It is almost inevitable that we are going to see a huge surge in the need for compassionate care in the community for people at the end of their lives.
"The need to ensure dying people have the best possible end of life experience has never been greater."
She added: “At Marie Curie, thanks to the generosity of our supporters, we’ve been able to expand and adapt our frontline services to support more people in crisis during the first wave of the pandemic, but we, as well as many other charity providers, can’t sustain the level of care needed in the longer term without more sustainable funding.”
Health Secretary Matt Hancock appeared to suggest that more support could soon be given to hospices.
He told ITV News: "We have put enormous support into the hospice sector. I'm always open to supporting them more.
"Hospices do an incredibly important job, an incredibly difficult job.
"They work very closely with the NHS, of course they do. And I admire the work of hospices and I want to make sure they get the support they need.Asked if that meant support would be coming, he said: "I'm willing to work very closely with the hospices who I think do an absolutely terrific job."