By Niki Ellis, CEO of Tapping House
There’s a persistent misunderstanding in our society, that hospices are places people go to die.
And while end-of-life care is part of what we do, that narrative only scratches the surface. What I wish more people understood, and what I feel a responsibility to say loudly, is this:
Hospices like ours are about living well. They’re about hope, dignity, connection, community, and support – often long before death is even on the horizon.
Many of us live in denial about getting older. Few want to imagine needing help with basic tasks, or becoming reliant on others. We often avoid thinking – let alone talking – about death. But the real conversation we need to be having is about ageing, and how we age well
The landscape we’re navigating
Earlier this year, Hospice UK shared a sobering report: two-thirds of people living in rural areas struggle to access the end-of-life care they need.
In West Norfolk – one of England’s most rural regions – that’s our reality. We see families who can’t get to hospital. Carers at breaking point. The individuals choosing not to seek help because the system seems too far away – or because a 45-minute drive feels like a mountain when you’re exhausted, grieving, or dying.
We know people want to be at home at the end of life. But we also know what it takes to make that possible in practice.
- We cover a huge rural area.
- Our Hospice at Home team spends 50% of their time just travelling between patients.
That’s not inefficient care – it’s the cost of geography. And yet, with just modest investment, we could create four outreach hubs across our region, instantly doubling or tripling the number of people we support every day.
Thanks to innovative services like our overnight Rapid Response team, we’re already delivering 81% more care than before – reaching people in moments of crisis, and helping them avoid unnecessary hospital admissions.
As our population ages, demand will only grow. Yes, it’s wonderful that people are living longer. But the bigger question is: are we living longer in good health – and with the right support?
A system not built for us – or with us
There’s growing momentum that care should shift from hospitals into communities. It’s where people want to be. It’s often where they stay well for longer.
At Tapping House, we’ve been doing this for years – not just advocating for it, but delivering it. From the point of diagnosis, we help people live well with their condition, manage symptoms, and feel in control all with the aim of preventing unnecessary 999 calls and hospital admissions caused by crisis and fear.
This is the future of healthcare: proactive, person-led, community-based.
It’s also one of the key priorities in the Government’s 10-year plan – and yet, hospices like ours are often not invited to the table when new models of care are being designed.
Take the proposed neighbourhood health and care hubs. They’re an exciting idea. But unless independent hospices are included in the planning stage – not brought in as an afterthought – we risk building a new system that still overlooks the people we’re best placed to support.
We’re already doing what the system says it wants. So why not build around those already delivering results?
The independent hospice sector, supported by Hospice UK, is ready to lead. We bring clinical expertise, deep community trust, and scalable volunteer networks. We don’t need reinvention. We need inclusion.
The care system of tomorrow must be designed with us – not just around us.
Rethinking rural care
There’s a hard truth we need to face: people in rural communities are not just far away – they’re often invisible to the system.
Norfolk is an attractive place for many to retire to, often without family nearby. There’s also an assumption that rural equals affluent. It doesn’t. We see deep disparities in wealth and access every day. And many live in areas where 30% of the homes are holiday lets. In places like these, loneliness isn’t just emotional – it’s structural.
And loneliness, we now know, is as bad for your health as smoking a pack of cigarettes a day.
So when people ask why we’re training our charity shop staff to be “Compassionate Friends,” why we’re rolling out death literacy training in the community, why we care about people bringing dogs into our charity shops and sitting for a chat – this is why.
Because that chat might be the only conversation someone has all week. And it might be the moment they find out they don’t have to go through this alone.
Compassion isn’t a luxury. It’s infrastructure
One of our most powerful tools isn’t a drug or a machine. It’s human presence.
Take our bereavement service: two psychotherapeutic counsellors, supporting ten trained volunteers. That’s not just a service. It’s a web of care.
Hospices have shown how integrating volunteers can transform the scale, reach, and resilience of care – especially in rural areas. Right now, huge sums are directed into private care agencies through continuing healthcare packages. But imagine if just a portion of that funding went into strengthening our Hospice at Home services.
If we’re serious about efficiency and impact, then we need to talk about how funding is allocated.
With a relatively small investment, we could create four community bases across northwest Norfolk. That change alone would dramatically increase the number of people we can visit each day – bringing care closer to those who need it, faster and more frequently.
Investing in community-based care isn’t just the compassionate thing to do – it’s also smart. It’s more cost-effective, more efficient, and more human. Our approach is scalable, sustainable, and most importantly, it’s already making a difference.
If the healthcare system is crying out for capacity, why aren’t we taking models that blend professional expertise with community support more seriously?
The truth is – we are. But we need the backing to scale it.
It takes a village – to live, and to die well
We all know the phrase: it takes a village to raise a child. But it also takes a village to support a good death.
It takes neighbours who check in. It takes local GPs, pharmacies, care homes, social workers, and volunteers collaborating – not operating in silos. It takes people having the courage to talk about dying, and the humility to ask for help. It takes systems that see hospice care not as a soft extra, but as essential infrastructure.
What gives me hope
Despite growing demand, underfunding, and workforce challenges – here’s what keeps me going:
● The hundreds (300+) of volunteers who show up, week after week.
● The families who donate a loved one’s clothes as a quiet, profound act of gratitude.
● The staff who choose to work with us, even when they could earn more elsewhere.
● The conversations we’re starting to have – about living well, dying well, grieving well.
● The power of community that, when activated, can do far more than any government department alone.
We need policy. We need funding. But we also need each other. Hospice care isn’t the end – it’s the thread that binds a community together through some of life’s hardest, most human moments.
My one wish
As Tapping House marks 40 years of compassionate care, my wish is this:
That hospices are recognised at a system level, not as extras, but as part of the solution. That we’re invited in from the beginning – to shape, build, and deliver the care people need.
Now imagine what we could achieve – if the system worked with us, not after us.
P.S. If you’re working to shift care into communities, or want to hear how we’re doing it on the ground, I’d love to connect. Let’s share what’s working and build something better, together.