End of life care in England and Wales is unable to cope with rising demand and requires billions of pounds of new investment, palliative care doctors opposing new laws on assisted dying have warned.
It is forecast about 130,000 more people in England and Wales will need palliative care by 2048. The Department of Health and Social Care has estimated the NHS is already spending about £6bn a year on palliative care.
The Association for Palliative Medicine, one of the world’s largest representative bodies of healthcare professionals practising end of life care, has issued a position statement in the debate over new assisted dying laws which says it opposes legislation because of various concerns, including “the lack of adequately funded specialist palliative care services”.
It also warns of safeguarding issues and “concerns about trust and the impact on doctor-patient relationships”. The association acknowledges that “while a substantial majority of members opposed [assisted dying], some of our members have a different view”.
Sarah Foot, a palliative care doctor and a member of the Association for Palliative Medicine, who is opposed to new laws to allow assisted dying, said there needed to an be overhaul of palliative care. “We shouldn’t need charities to fund it,” she said. “We need to invest in the workforce and invest in the palliative beds so people can die comfortably.”
Rachel Clarke, a specialist in hospital palliative care, said she had decided not to state her general position on assisted dying because of her relationship with patients, but considered “categorically” that the law should not be changed at this time because so many patients were being “wholly failed” at the end of life.
She said: “My concern is that if we change the law without adequate resourcing of palliative care, then there will be people who choose to end their lives because they weren’t being provided with the care they needed.
“I sometimes see patients [near the end of life] who come into hospital in unspeakable agony and want their lives to end. It is not because their pain cannot be prevented, but because they are not getting the care they need. Labour and Conservative governments have failed to provide adequate palliative care for patients.”
Clarke said there should be significantly more investment to “fix” palliative care in advance of any legislation debate on assisted dying.
A report published by Marie Curie, the UK’s leading end of life charity, has forecast the number of people who would benefit from palliative care in England and Wales will increase to more than 646,000 by 2048, an increase of more than 25% compared to 2023.
Palliative care services are provided in hospitals, hospices and the community. Hospice UK warned in July that one in five hospices were cutting services in the worst funding crisis in two decades.
In evidence to the Commons health and social care committee last year, the then health minister Helen Whately said there was variation in access to care. She said in addition to the £6bn a year spent by the NHS on palliative care, the hospice budget was about £1.6bn a year.
A bill was introduced in parliament on Wednesday which aims to give terminally ill people with only months to live the right to end their lives, subject to the agreement of a judge and two doctors. Molly Meacher, who introduced an assisted dying bill in the House of Lords in 2021, has said she wants any new legislation to be accompanied by more investment in palliative care.
The debate over the bill has divided both major political parties and revealed splits within the Church of England, with the archbishop of Canterbury, Justin Welby, arguing against and his predecessor but one, George Carey, coming out in favour.
Brenda Hale, a former president of the supreme court, said this weekend that it was “not a very Christian thing” to allow someone to continue to suffer if they wanted help to end their lives.
In a conversation with the former archbishop of Canterbury Rowan Williams for Prospect magazine, Lady Hale said: “It’s not a very Christian thing to do to oblige somebody to go on suffering unbearably when they do not wish to.”
A vote on the terminally ill adults (end of life) bill is expected to take place on 29 November. If the bill passes in the Commons, it will go to committee stage where MPs can table amendments, before facing further scrutiny and votes in both the House of Commons and the House of Lords.
A government spokesperson said: “This government wants a society where every person receives high-quality, compassionate care from diagnosis through to the end of life. We are determined to shift more healthcare out of hospitals and into the community, to ensure patients and their families can access the personalised care they need, in the most appropriate setting.”
