Accounting for the Hospice Business Model in England
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This thesis evaluates the viability of palliative and end of life care provision by voluntary hospices in England. Literature on voluntary hospices’ management and financial feasibility is fragmented and scattered within and across academic and practitioner discourses. It can still however be consolidated to lay the foundations for developing a study that reveals how charitable income streams, donated to underwrite hospices’ activity, are significant relative to Government funding. Using a mixed methods, inductive approach, I construct a ‘descriptive business model’ for hospices which is grounded in analysis of relevant accounting information, and supported by narratives extracted from interviews with senior clinical and non clinical managers from four large and medium sized hospices. The study reveals the strengths and weaknesses of the hospice business model and evaluates its robustness against forthcoming challenges. The thesis findings highlight the gradual transition from a basic voluntary sector business model, to a complex, highly sophisticated, and institutionalized care establishment, which is sharing many of the characteristics found in large private and public organizations. The sustainability however of the business model is threatened due to its exposure to a number of contradictory forces. Whilst demand for palliative and end of life care going forward is set to increase, due to both demographic and regulatory factors, hospices' voluntary income is highly volatile. Dependency on sustaining a complex network of stakeholder groups to underwrite income, challenges the hospice business model’s ability to cope with the anticipated challenges.
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