Letter from John Pickard, Brentwood and Ongar Labour member
Like a lot of Labour Party members and activists, I am torn in the debate about assisted dying and the bill currently going through parliament. In principle, someone with a terminal illness should have the right to die with dignity at a time and in a place of their own choosing. But the debate is overshadowed by serious failings in the care system.
I was drawn to an article in the Guardian, which led me to a report on palliative care from the Office of Health Economics (EHO). The EHO published a report in 2019 about the availability of palliative end of life care and they recently updated their data.
The gist of their commentaries, both in 2019 and today, are that for all of those who need palliative care, it is only available for a minority.
The new EHO data shows show that “an estimated 436,022 people in England needed palliative care in 2023”. However, across the UK, “an estimated 7,329 people per year – or 20 people a day – die with no pain relief in the last 3 months of their life, even if the highest levels of hospice-level care are available.” These estimates, the report adds, use, “conservative assumptions that provide the lowest possible estimate”.
It means, the new report notes, that between 2019 and last year, there has been a 15% increase in the number of people “dying in completely unrelieved pain, even at the highest standards of palliative care in England”.
An important priviso must be added to the OHE figures, because, as they point out, fewer than one in twenty of terminally-ill patients who need hospice care actually receive it.
The reason why these statistics are important is that it ought to be possible, even for terminally-ill patients, to die with dignity and free of pain – and they might, if they were provided with palliative care. Almost all hospice care these days relies on charities of one sort or another, and many of these are now threatened financially because of the increase in employers’ National Insurance payments. It is already the case that the poorest patients are the least likely to get hospice care – that will be even more true in the future.
If we had a National Health Service that wasn’t plundered wholesale by private profiteers, then there might be the possibility of the NHS providing hospice care of a good standard and on sufficient scale, working with charities if necessary. But it is wrong that palliative care in a hospice depends on charities and that it is effectively rationed.
The conclusion that has to be drawn is that the discussion on assisted dying should not be a moral debate – but it should focus on the economic and class dimensions that are rarely aired.
