In November 2024, during the second reading of the Terminally Ill Adults (End of Life) Bill in the House of Commons, its sponsor Kim Leadbeater MP noted a recent increasing interest in the quality of palliative care services following the bill’s introduction.
Within the debate itself, MPs raised concerns about the bill’s impact on palliative care. For example, Conservative MP Danny Kruger argued that palliative care professionals “are opposed to a change in the law by a great majority” over concerns about its impact on services and on vulnerable patients.
“With this new option and the comparative loss of investment and innovation in palliative care, real choice will narrow,” he said.
Liberal Democrat MP Layla Moran, Dame Meg Hillier and others called for a separate debate on palliative care before the assisted dying bill progresses, to get firm commitments from the government about how they plan to improve palliative care in the UK.
There is evidence to support these concerns and calls for these commitments. Earlier in January 2025, Ben Bowers, a clinical academic community nurse with the University of Cambridge and Queen’s Nursing Institute who specialises in palliative and end-of-life care, told The Pharmaceutical Journal that these services are facing “a wicked problem” owing to rising demand.
In July 2023, Marie Curie estimated that, if the proportion of people requiring palliative care remains the same, the number of people with palliative care needs in the UK would increase by more than 147,000 between 2023 and 2048 — a rise of 25%.
Services are already struggling to meet the current demand, particularly in the community
But services are already struggling to meet the current demand, particularly in the community, with data showing that 64% of people spend the last three months of their life in private homes. In 2022, a Marie Curie survey of NHS staff across 60 areas of the UK revealed that only 25% respondents had a pharmacy open throughout the night in their area that could dispense palliative care medicines, while only 30% had access to healthcare professionals who could administer these medicines throughout the night.
The result is what the Health and Social Care Select Committee described in February 2024 as “patchy” service provision.
A more recent debate in the House of Commons on hospice and palliative care, held in January 2025, also highlighted variable access in provision. Liberal Democrat MP Paul Kohler noted that adult hospice funding ranges from just £0.23 to £10.33 per head of population across different integrated care boards.
Tarun Nayyar, senior clinical pharmacist at Birmingham Hospice, has also told The Pharmaceutical Journal that “there are many groups of patients who we struggle to reach in delivering effective palliative care and symptom relief,” which he said increases the risk of patients and their families confusing the role of hospice care “with that of assisted dying” and presents a possible further barrier to provide end-of-life care.
“The biggest challenge will be to create a model of healthcare delivery that integrates a carefully placed role for assisted dying, within an exceptional palliative care service that offers patients a true choice on how they want to be cared for,” he said.
Other countries appear to have struck a suitable balance between assisted dying and palliative care. Canada legalised medical assistance in dying (MAiD) in 2016, with data from the 2022 annual report on MAiD in the country showing that 4 in 100 deaths in Canada were medically assisted in 2022.
James Downar, professor and head of the division of palliative care at the University of Ottawa in Canada, told MPs as part of their inquiry into assisted dying in January 2023, that following its legalisation, “funding/support for clinical palliative care increased dramatically in much of the country”.
This included “a large growth in funding and salaried positions for palliative care physicians”, and “CAN$3bn invested in home care in 2016, much of which went to palliative care services”.
He added that even during the COVID-19 pandemic, the availability of assisted dying did not diminish access to palliative care, with “only 126 of 7,394 people (1.7%) who received MAiD unable to access the palliative care services that they needed”.
It is imperative that the government build the “exceptional palliative care service” that meets patients’ needs
Similarly, results from a study published in the Journal of Medical Ethics in 2015 that looked at how the 2002 legalisation of assisted dying has impacted palliative care in Belgium revealed that “the hypothesis that legal regulation of physician-assisted dying slows development of palliative care is not supported”.
“On the contrary, regulation appears to have promoted the expansion of palliative care,” the researchers found.
Assisted dying legislation has had a similar effect in Australia, where Brian Owler, a consultant neurosurgeon at Norwest Private Hospital, New South Wales, said the introduction of voluntary assisted dying “has provided funding and shone a spotlight on the activities of palliative care”.
It is unclear whether palliative care in these other countries was in a similar state as it is in the UK right now when they legalised assisted dying; however, the evidence supports the persistent refrain throughout the parliamentary debates and government reports — that palliative care and assisted dying can go hand in hand. But this makes it imperative that the government build the “exceptional palliative care service” that meets patients’ needs now and in the future.
As the population ages and as advances in medicine mean people live longer with more complex needs, after fixing the social care system, this will be the next biggest challenge for the government. PJ
