Legalisation of assisted dying may force NHS cuts, Wes Streeting warns

Civil servants are looking at the extra costs that assisted dying would impose on the NHS amid a warning from Wes Streeting that some services may be cut to fund expanded end-of-life care.

The health secretary has asked officials at the Department of Health and Social Care (DHSC) to analyse potential implications for NHS services if the right to die is legalised in England and Wales.

Their work is under way amid an increasing focus on how the NHS would cope with helping what the MP spearheading the push for assisted dying believes would be hundreds of people a year who have just six months or less to live to end their life early.

DHSC officials have already begun examining the costs of the practicalities involved, which could include expanding the services provided by hospitals or district nurses, for example.

The disclosure comes after Streeting made clear his view that legalisation could force the health service to make difficult decisions about funding some existing services.

“There would be resource implications for doing it. And those choices would come at the expense of other choices,” he told Times Radio on Wednesday.

Asked if he would have to find the money to fund an extension of palliative care from elsewhere in the NHS budget, Streeting replied: “Yep. To govern is to choose. If parliament decides to go ahead with assisted dying, it is making a choice that this is an area to prioritise for investment. And we’d have to work through those implications.”

Later on Wednesday, speaking to the media at the NHS Providers conference in Liverpool, Streeting again highlighted his belief that legalisation could put pressure on the NHS budget.

He said: “I’ve asked my department to look at the cost [of providing more end-of-life care]. Now that we’ve seen the bill published, I’ve asked my department to look at the costs that would be associated with providing a new service to enable assisted dying to go forward.

“That work is now under way, so I can’t give you a precise figure today. I’ve asked the department to look at the cost of implementing the bill as it is currently laid before parliament.”

Pressed on what services might lose funding for enhanced palliative care, he declined to specify any. But he added: “There are choices and trade-offs. Any new service comes at the expense of other competing pressures and priorities.”

Streeting – who plans to vote against assisted dying – voiced his fear that it could lead to some people with a terminal diagnosis choosing to end their lives early as a way of saving the NHS money.

“You do touch on the slippery slope argument, which is the potential for cost savings if people choose to opt for assisted dying rather than stay in the care of the care providers or the NHS,” he said in answer to a question.

“I think that is a chilling slippery slope argument, and I would hate for people to opt for assisted dying because they think they’re saving someone somewhere money, whether that’s relatives or the NHS. I think that’s one of the issues MPs are wrestling with as they decide how to cast their vote.”

He said MPs weighing up their stance on the terminally ill adults (end of life) bill should not necessarily vote against it because of that potential competition for resources within the NHS, and should consider all the arguments about assisted dying.

But, referencing the tightness of public finances, he again stressed the potential dilemmas facing the NHS if legalisation happened, saying: “We do need to be in the business of making choices.”

Interviewed on BBC Radio 4’s Today programme earlier, Streeting said the NHS could ramp up the palliative care system in order for it to take on the responsibilities assisted dying would entail. He has previously stated that palliative care was not “where it needs to be to give people a real choice”.

Streeting plans to vote against the Labour MP Kim Leadbeater’s bill when it comes before parliament on 29 November, in what will be the first House of Commons vote on the issue since 2015.

Downing Street would not be drawn into saying whether the health secretary was right to raise the spectre of assisted dying law coming at the expense of other NHS services.

Asked about Streeting’s remarks, the prime minister’s official spokesperson said: “Ultimately, this is a matter for parliament to decide and that is why it is going to be a free vote, and parliament will debate the principles and merits of assisted dying and the issues surrounding the bill.”