Assisted dying: Care providers concerned over risk of workforce ‘division’

Care providers in England have raised concerns about potential staffing challenges and ‘division’ within the workforce should assisted dying be legalised.

Care England has urged the government to provide care homes with a ‘clear roadmap’ on how assisted dying would be implemented, following concerns that providers were at risk of being ‘dangerously unprepared for what lies ahead’.

The concerns come ahead of the second reading of the Terminally Ill Adults (TIA) Bill in the House of Lords this week.

The Bill, which was voted for by MPs in July, would allow terminally ill adults with six months or less to live to receive medical assistance to end their own lives in England and Wales.

It is currently going through scrutiny in the House of Lords.

Care England said that while it takes ‘no position’ on the principle of the Bill itself, it has a duty to ensure concerns of the sector are heard and wants to ensure that any potential implementation is ‘carefully planned’.

Ahead of the next reading of the Bill, Care England surveyed 122 care providers in August about the move to legalise assisted dying.

Findings suggested that 84% of providers said they had not been consulted on the Bill or its implications.

Almost a quarter (24%) said staffing would become ‘very difficult as many staff would conscientiously object’ and only 13% said they could manage assisted dying in their homes.

Some 14% reported staff being willing to participate in the whole procedure, while 34% reported their staff not being willing to participate at all.

In the Bill, nurses are referred to under the title of ‘health professional’, which includes registered nurses, registered medical prescribers, a registered pharmacist or a registered pharmacy technician.

The Bill states that the ‘coordinating doctor’ who is overseeing the patient’s end-of-life care provision may be accompanied by ‘other such health professionals’ – including nurses – that they think are needed.

However, no registered medical practitioner or ‘other health professional’ would be under any ‘duty’ to participate in assisted dying provision.

Care England said that while staff have a right to opt out, survey respondents raised concerns about ‘division within the workforce and the challenges of rigid shift patterns’. And it stressed that this came on top of existing pressures caused by high vacancy rates and low retention across the sector.

A further 16% of care providers said they were unsure whether the purpose of care homes would be ‘undermined’, with many requesting more information about implementation before commenting further.

Chief executive of Care England Professor Martin Green said: ‘Our role is not to debate the principle of the Terminally Ill Adults Bill, but to ensure the care sector is ready should the legislation proceed.

‘In its current form, and without clear guidance from government, the Bill could present significant challenges for providers and staff working with people in care settings.’

He added: ‘Engagement with the sector so far has been minimal, as our survey demonstrates.

‘What is needed now is not rhetoric, but a precise, coherent, and actionable roadmap for delivery.

‘The sector cannot afford to wait until after the Bill passes to begin these critical discussions.’

Professor Green urged the government to use the survey results as ‘a serious reflection of the sector’s concerns’ and warned that without a detailed implementation plan, providers would be ‘dangerously unprepared for what lies ahead’.

A survey carried out by Nursing in Practice earlier this year found that almost two-thirds of general practice nursing staff were supportive of the assisted dying bill, though less were sure on their involvement in providing care to support it.

In January, the Royal College of Nursing (RCN) stressed it was ‘absolutely vital’ that nurses were included within the education and training that would be created if assisted dying legislation was introduced.

The Department of Health and Social Care was contacted for comment.