The call for reform in the palliative care system has intensified in light of recent parliamentary developments concerning assisted dying legislation in England and Wales. Senior doctors, particularly from the Association for Palliative Medicine (APM), are advocating for urgent changes to ensure that palliative care is adequately funded and prioritized before any laws permitting assisted dying are enacted. They warn that the resources required to implement assisted dying procedures may divert funds away from essential end-of-life care services, raising concerns about an already strained system.
The APM’s position reflects a growing unease regarding the current status of palliative care, which is seen as insufficient to meet the needs of dying patients. They have called for the establishment of a government-led commission dedicated to overhauling end-of-life care, highlighting the detrimental impact of funding shortages and poor service coordination that already deny many dying individuals access to necessary care.
The urgency of this intervention comes on the heels of a significant vote in Parliament, where MPs indicated their support for changing the law around assisted dying. While this vote represents an important legislative step, there will be many additional discussions and votes before the proposed bill can potentially become law. With this political backdrop, the APM’s appeal for palliative care reform gains considerable weight. Dr. Sarah Cox, the president of APM, emphasized that this is the moment for action, referencing Health Secretary Wes Streeting’s prior comments about palliative care shortcomings as an explanation for his inability to support assisted dying at this juncture.
Despite the UK’s reputation for possessing one of the finest palliative care systems globally, Dr. Cox openly questioned this notion, asserting that the current funding structures are inadequate. The pressures on palliative care services are stark, as indicated by reports revealing that around three-quarters of individuals in the UK will require palliative care toward the end of their lives—amounting to approximately 450,000 people each year. Unfortunately, recent findings from the end-of-life charity Marie Curie reveal that around 100,000 individuals may go without such necessary care, sparking dissatisfaction among families concerning the quality of care provided to their loved ones during the final stages of life.
Audit statistics are particularly concerning, demonstrating that a significant proportion of hospitals fail to offer specialist palliative care services on a continuous basis, impacting the overall quality of end-of-life care provided. Furthermore, hospices—an essential component of palliative care—struggle financially since around one-third of their funding comes from the National Health Service (NHS), with the remainder having to be independently raised. This dependency on variable funding sources has been critiqued as “not fit for purpose” by parliamentary reports.
Adding complexity to the debate, some MPs supporting the assisted dying legislation have suggested that legalizing assisted dying might inadvertently bolster improvements in palliative care. They referenced findings that in some countries, introducing assisted dying had coincided with enhancements in palliative measures. However, Dr. Cox challenged this assumption by calling attention to the mixed results seen in other nations, reiterating that health budgets are limited and that the NHS already grapples with financial constraints.
Calls for better coordination among hospitals, community health teams, care homes, and hospices resonate as major priorities in improving palliative care services. It is noted that training for healthcare providers outside of specialty palliative care is also lacking, which can adversely affect the quality of service delivery.
In alignment with this perspective, Sam Royston, director of policy at Marie Curie, has reiterated the pressing need for substantial improvements in end-of-life care, emphasizing that despite the complex conversations surrounding assisted dying, a strategy to enhance palliative care is essential. Royston underscored the neglect of dying individuals’ needs and highlighted the absence of cohesive plans across the United Kingdom to address palliative care issues.
Conversely, some experts, including retired palliative care doctor Prof. Sam Ahmedzai, provided a more optimistic perspective, noting that in certain jurisdictions where both assisted dying and palliative care operate simultaneously, each system can successfully enhance the other. The importance of giving attention and training to the primary care providers who often deliver palliative care, such as general practitioners and nurses, is also stressed as a crucial area for development.
As discussions continue within Parliament, with a notable emphasis on the necessary reforms to palliative care, the Department of Health and Social Care has been engaged to provide further commentary on these pressing issues. The intersection of legislation regarding assisted dying and the urgent need for improved palliative care services represents a critical conversation that will shape the future of healthcare for individuals at the end of their lives.
