Assisted dying and the importance of hospice care
It is disturbing that parliament is considering the legalisation of assisted death while simultaneously putting more financial pressure on the services that really help people to die with dignity.
While parliament is in recess, I am spending most of my time working on the programme and speakers for this year’s Battle of Ideas festival in London on 18 & 19 October. (What do you mean you haven’t got your ticket yet?! You should head over to our ticket page now!) I am also preparing for the legislative period ahead. One crossover is the theme of assisted dying, which we will be discussing at the festival, and Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill is also one key laws that I will be involved with back in Westminster as it starts its passage through the Lords on 12 September.
I have serious reservations about this law in principle, given that it will fundamentally change the relationship between the state and individuals, and between the NHS and patients. One worry I have is that so many safeguarding amendments were either never discussed or were voted down in the House of Commons. Huge concerns have rightly been raised about the way this bill, on such a weighty matter, was introduced by means of a private members’ bill. Moreover, the committee that was supposed to scrutinise the legislation was stacked with a majority of supportive MPs, a disproportionate amount of ‘expert’ testimony was from those in favour of the Bill, and MPs were given insufficient time for proper debate.
One amendment I will be arguing for, that MPs rejected, is to allow certain hospices and care homes to opt out. With barely any debate, it was voted on and was defeated by 279 votes to 243 in the Commons. As former No10 director of legislative affairs Nikki da Costa (who will be speaking at the Battle of Ideas) commented on X, it now ‘looks like there will be no hospice, nor care home, where you can be certain ending the life of the terminally ill will not be suggested nor normalised’.
For me, this is a red flag. Unsurprisingly, hospice doctors, who well understand the complexity of death, are overwhelmingly opposed to legalising assisted death. A 2019 survey found that 81 per cent of them were against it. The best way to procure a ‘good death’, in my opinion, is through hospice care, whose expertise is precisely in offering unparalleled dignity to patients in their care, as they face the end of their lives. I think we should be putting all our energies and resources into improving funding and access to desperately needed palliative-care services and hospices, instead of enacting a law that normalises suicide and arguably puts the most vulnerable at risk.
In this context, I was shocked to hear that St David's Hospice in Holyhead (in North Wales, where I grew up) has been forced to close its doors in October. It has served the community of Holyhead and the wider Anglesey region for years, offering palliative and end-of-life care to countless individuals and their families. I became aware of this from an old friend, Gel Murphy, whose 61-year-old brother Brian recently passed away after a brave battle with cancer after a stay in this hospice.
Gel tells me: ‘We were there with him, the staff are angels, they always went an extra mile. They made food and put us up. The hospice staff at Holyhead are amazing. They even put myself, my sister and niece up.’ The decision to close this vital facility, with its specialised local support network and access to dedicated professionals, would leave a significant gap in the healthcare services and increase the strain on families who are already grappling with the emotional and physical demands of caring for a loved one with a life-limiting illness.
Hospices like St David's are part of a wider network of hospices in Wales that provide essential care to more than 20,000 children and adults affected by terminal and life-limiting illnesses each year. Ironically, they provide a huge cost saving for the NHS, with over two thirds of hospice care delivered through charitable fundraising, rising to over 85 per cent for children’s hospices. Bangor University Research last year found that the mean cost for a hospice patient staying for 14 days was £5,708, compared to £6,860 for the cheapest hospital-based option.
However, despite the fact that significant public expenditure savings could be achieved through increased utilisation of hospice-based care (statutory funding as a proportion of hospice care expenditure across Wales was just 30 per cent and St. David’s Hospice receives just 24 per cent) now every hospice in Wales is forecasting a deficit for this financial year.
While healthcare in Wales is notoriously under par, this funding crisis is replicated throughout the UK. Government policies, such as the national insurance hike and minimum wage increases mean that the hospice sector is having to consider significant cuts.
Incredibly, while the NHS is exempt from the national insurance rise, private and charity-run health and care organisations are not. Leaders of some charitable organisations that administer health and social care have aired their concern that can this only exacerbate budget pressures and could mean further cutbacks in a sector that has already seen beds close and nurses laid off to save money in the last year.
Lord Howard of Lympne, a Conservative peer and vice-president of Hospice UK’s board of trustees, said the additional contributions would create estimated additional costs of £34m per year for hospices. I, along with a majority of peers, supported an amendment, tabled by Liberal Democrat peer Baroness Barker, to amend the National Insurance Contributions (Secondary Class 1 Contributions) Bill.
In the meantime, the likes of St David’s Hospice need solidarity, so it would be great if you can sign and share this petition to urge the decision-makers to keep St David's Hospice open in Holyhead and ensure it continues to provide its invaluable services to our community.
And politically, we should resist the chilling reality of politicians pushing state-assisted suicide, at the very time when policies designed by parliament are so carelessly denying crucial end of life care and facilities.
Rob Bashforth
This Substack is dedicated to a good friend of the Academy of Ideas, Rob Bashforth, who died suddenly, far too young, in July. A reminder to me that we should never want those we love and cherish to die a minute before they need to. Rob’s funeral will be held on Thursday 14 August at St Austin’s Church in Wakefield. A dedicated teacher and educator, a football fanatic, a musician, public intellectual, freedom fighter and great mate to so many. Rob was also very funny. We never had a dull conversation – he was always challenging, a rebel, committed to freedom, smart, questioning, open-minded, always pushing for what next politically. But mainly he was a devoted father to Aaron and Amphon – my God he loved those boys to bits.
So, condolences to Rob’s sons, family and multitude of friends. Yes, he is irreplaceable and much missed already, but we will carry on the work of the Academy of Ideas very much inspired by Rob’s passion for ‘changing politics for good’. Two recent memories: he joined us at The Academy and with typical life-affirming panache and a mad-cap sense of daring, joined in the wild swimming (as well as the debates).
And Rob also spoke at a panel on AI at the Buxton Battle of Ideas in 2023. (You can listen to the debate here.) AI is an issue he pestered me to take more seriously than I was. He was right!