Macmillan End of Life Care Fund

Published: 12 September 2023

Macmillan Cancer Support has been working in partnership with Social Finance, experts in social investment, since 2015 to find new and innovative ways to improve services that support people at the end of their lives. 

This partnership has led to the development of the Macmillan End of Life Care Fund by which Macmillan provides up-front funding for services which is repayable if mutually agreed outcomes are met, thereby absorbing the financial risk. The fund will see Macmillan invest up to £36m in end of life care services across the UK with no financial return.

What we know about EOLC 

Our evidence shows that 81% of people would prefer to die at home, yet 50% of people die in an acute setting, as well as spending an average of 25 days in that setting during the last 12 months of life. Over 30% of hospital capacity is occupied by patients at end of life and 65% of nurses found it hard to give good care to dying patients due to staff shortages in the NHS and the social care sector.

Our aims

  • We want to ensure that people approaching end of life are identified early and have access to high-quality, personalised EOLC services. 
  • We want to make sure people receive equitable EOLC that takes into account their choices, wishes and preferences. 
  • We want to support health and social care professionals to work in an integrated way across organisational boundaries. 
  • We want to promote outcomes-based contracting for end of life across the UK.

What is social investment? 

Social investment is the use of repayable finance to help an organisation achieve a social purpose. It is only repaid if mutually agreed outcomes are achieved. We will co-design the financial model with you to meet your priorities. The social investment provided by Macmillan is not a grant or a loan, meaning that this funding source is open to all partners including NHS bodies. There are no interest charges and outcomes payments will never exceed the total service costs, funded in full by Macmillan, and systems fully retain any benefit surplus.

Why use social investment? 

  • Shifts focus to achieving outcomes and away from activity and inputs. 
  • Reduces both non elective activity and the need for use of private/​escalation wards creating capacity to address elective backlog. 
  • Macmillan absorbs financial risk allowing for innovation in the system. Supports long-term sustainability of services. 
  • Supports systems to transform services to tackle inequalities and offer the right care at the right time in the right setting.

What does the Macmillan EOLC Fund offer? 

  • Upfront Investment from Macmillan – repayable only if outcomes are achieved, and capped at the cost of the service. 
  • Programme Expertise – on programme management and business case development, contracting sharing learning from previous projects. 
  • Financial Expertise – including how to account for social investment within the NHS. 
  • Clinical Expertise – to support development of the service model, implementation and ongoing delivery.
  • Data analytics – initial data analysis to inform business case development and ongoing access to automated dashboards to ensure agile service management and continuous quality improvement.

We have been working with clinicians, operational managers, finance teams and others to understand the challenges that they are facing. These include; non-recurrent funding, financial pressure that makes it hard to re-allocate resource within a system, fatigued front-line staff unable to innovate, patients not being identified in a timely way and not having their needs consistently assessed with personalised care plans put in place. 

The Macmillan Fund Team is experienced in tailoring its approach to our partners’ needs. We have worked with partners in the NHS, local authorities and third sector, to provide additional programme management capacity as well as clinical, financial and data analysis expertise. We have a tried and tested approach to understanding population data and unmet need that we will apply with you to your locality. 

Through services funded by the Macmillan EOLC Fund, we align system benefits with what people want; personalised, quality care that is accessible to all. This approach will drive real, sustainable system changes and improve patient experience. An example is the first service funded by the Macmillan Fund which is in Oxfordshire and aims to reduce the length of stay in the last year of life through a home hospice, hospital rapid response, palliative care crisis team and a coordination hub. To date the programme has halved the number of bed days for patients who have used the service. 

Funding criteria

A service that supports people over the age of 18 in their last 12 months of life. 

Exclusions include — research projects, evaluation projects, capital builds, contracts under £800k over three years and standalone posts 

Funding is generally for the initial three years of the service with outcome payments starting once the service is established.

To find out more about the Macmillan End of Life Care Fund please look at the resources below, you can also contact us at

Further information

The following resources will support you through the application process. You can also contact us at

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