Social care appeared nine times in Labour’s manifesto. Reforming the system is becoming increasingly urgent: the sector is in crisis. Demand for care has ballooned, as the full weight of the UK’s ageing population has begun to be realised, nearly bankrupting a growing number of councils in the process. Reforming the UK’s stance on assisted dying did not appear once.
It is surprising then, that shortly after entering government Labour has given next to no space to the former issue and ample airtime to the latter. In fact, the government’s only move on social care so far has been to scrap the proposed £86,000 cap on care costs less than a month after the election – a move which was described by the reform’s architect Andrew Dilnot as a “tragedy”.
Instead, the past week has seen the UK’s assisted dying laws dominating headlines. On Monday 16 October, MPs vote in a private members bill tabled by Kim Leadbeater the MP for Batley and Spen – the Choice at the End of Life for Terminally Ill Adults – which would give terminally ill adults with less than six months or less to live access to medical help to end their own lives. Leadbeater described the UK’s current laws as “not fit for purpose” and said she hoped the bill would “facilitate an open, robust, compassionate debate”. The outgoing cabinet secretary Simon Case has said the government will remain neutral on the bill, and MPs will be given a free vote.
Keir Starmer is said to have offered the promise of a free vote to Esther Rantzen, the former TV presenter who is a vigorous campaigner on this issue, ahead of July’s general election. Rantzen, who has stage four lung cancer, has signed up to Dignitas in Switzerland and has mounted a campaign in recent months for a relaxation of the UK’s laws to allow those with terminal illnesses a “merciful end”.
Putting the morality of this issue aside, the optics are challenging: the government appears to be ignoring the fragile state of social care and concentrating on assisted dying instead. Labour promised to improve ailing healthcare services after years of chronic neglect, and has the mandate to do so. Going full force on assisted dying does nothing to improve those services, and in fact removes vital oxygen from discussions of how we might improve the lives and care of elderly people.
Our social care system has never been in a more dire state. The sector, which provides long-term care for 835,000 people, has been operating with upwards of 100,000 staff vacancies for several years. This can make it near-impossible for elderly people and those with disabilities to access the support they need. Across the country, they are routinely forced to endure exhausting waiting times for essential care. A freedom of information request by the Health Service Journal earlier this year showed that average waiting times in Bath and Northeast Somerset have stretched to 149 days (almost five months).
This is not sustainable. Over the next 40 years, the size of the population aged between 65-79 is predicted to increase by nearly a third, with the number of those aged over 80 set to double to more than six million. We do not have the capacity to properly care for our existing elderly, so we certainly do not have the capacity to deal with an exponential growth in the demographic. Ensuring elderly people have access to dignified care in life should be a precede a move towards assisted dying.
It is a sensitive issue – one which the UK will need to reckon with in coming years. But under the current social care circumstances, we should be wary of the slippery slope. Looking at other jurisdictions where assisted dying has been made legal should offer a cautionary tale. Terrible reports have surfaced from Canada, in which vulnerable people often unable to access adequate care, have felt coerced or encouraged towards ending their lives. These should be heeded as a warning for what can happen when work to improve and maintain care for elderly and disabled patients has been neglected in favour of the state taking a premature stance on a tricky moral problem.
Though government is set to remain neutral on the question, health and social care secretary, Wes Streeting is said to be “conflicted”. He has expressed concern that the country’s end of life care is not in an adequate state to prevent coercion yet in the same breath said he thinks the time is right to debate this issue. But with a health and social care system in crisis, he cannot afford to remain equivocal. This government was elected to regenerate our ailing, unwieldy healthcare landscape. Instead of debating the moral merits of assisted dying it must first discern how it plans to help people live.
