Month: June 2025

Assisted Dying: Serious Practical Questions Remain Unanswered

MPs who voted in support of assisted dying — and indeed many doctors and other healthcare professionals who support such measures — may not have fully considered the profound practical challenges this would present for the NHS and for medical education and training.

Implementing an NHS-based assisted dying service would be a vast and complex undertaking. At present, the NHS is neither prepared nor equipped to deliver such a service in a safe, equitable, and ethical way. There is no public funding allocated for assisted dying. As Secretary of State Wes Streeting has rightly pointed out, any future funding would inevitably have to come at the expense of other health services that are already under considerable strain.

Beyond funding, the educational and professional implications for the medical workforce have barely been addressed. There has been no clear plan for how assisted dying would be integrated into undergraduate medical education or postgraduate clinical training — nor how issues of conscientious objection, professional standards, and clinical governance would be handled in practice. Integrating assisted dying into undergraduate education and postgraduate training would require new frameworks, ethical guidelines, and practical training modules. Developing these educational and training programmes would take years and require significant investment, with no clear plans for this currently in place.

The complexity of implementation—financially, educationally, and ethically—suggests that any move toward assisted dying would require far more planning than current discussions reflect. Without addressing these fundamental questions, any move toward legalising assisted dying risks creating more problems than it solves. Policymakers, healthcare leaders, doctors, other healthcare professionals and the public deserve a much fuller and more honest debate about what such a profound change would truly require.

Balancing Free Speech and Institutional Responsibility in England’s Universities

The Office for Students (the independent regulator of higher education in England) has suggested that students should be prepared to be “shocked and offended” at university as part of the educational process. This policy seeks to promote freedom of expression and open debate within academic settings. However, implementing such an approach poses significant challenges for both university staff and students. Institutions must not only consider the legal boundaries surrounding freedom of expression in the UK but also manage the practical and ethical complexities involved in fostering an environment that encourages robust discussion while protecting the rights and well-being of all members of the university community.

The first challenge for universities is that the UK does not allow full freedom of expression. There are many laws that limit what people in the UK can say, and these are often different from limits on freedom of expression in other countries. For example, the USA generally has fewer restrictions on freedom of expression than the UK.

UK laws aim to balance freedom of expression with other societal interests, such as public safety, national security, and the protection of individual rights. Some of the relevant laws include:

1. Public Order Act 1986

2. Communications Act 2003

3. Malicious Communications Act 1988

4. Defamation Act 2013

5. Counter-Terrorism and Border Security Act 2019

6. Online Safety Act 2023

7. Obscene Publications Act 1959

8. Equality Act 2010

Universities will have to consider whether the views that their staff and students express are in breach of any of these laws. Incorrect interpretation of the law by universities may expose them, and the staff or students expressing potentially illegal views, to legal action.

Beyond legal constraints, universities face additional challenges in enforcing internal policies. As responsible employers, universities will have policies to address issues such as bullying, harassment, and discrimination — particularly in relation to protected characteristics such as sex, ethnicity, and disability. Failing to protect individuals or groups could result in internal complaints, referrals to external bodies such as the Office for Students, and potentially legal action. The dividing line between what is legal and illegal may not be clarified until tested in court. For example, how does allowing students to be “shocked and offended” align or conflict with the legal duty to prevent harassment?

The government has not provided clear evidence that a major problem exists regarding staff and students being unable to express their views freely within UK universities. What we may see instead is an increase in complaints and legal challenges, which could consume significant institutional time and resources. Although the aims of the Office for Students may be well-intentioned, the practical challenges of implementing this policy are considerable. Universities must carefully navigate complex legal frameworks and their own institutional responsibilities to ensure both freedom of expression and protection from harm.

Without clearer guidance and stronger evidence of a significant underlying problem, there is a risk that universities will expend considerable time and resources responding to legal uncertainties and complaints. A more constructive and collaborative approach — one that supports universities in fostering open debate while upholding legal and ethical standards — may ultimately prove more effective in promoting freedom of expression within higher education.

Abolishing NHS England will make only modest savings

Abolishing NHS England and reducing Integrated Care Board (ICB) staffing by 50% may appear substantial, but the projected savings – around £500 million annually if fully achieved – would represent only a modest increase (approximately 0.25%) in annual NHS funding in England, given the NHS England budget is approaching £200 billion per year. Evidence from past NHS reforms (like the 2012 Health and Social Care Act) shows mixed results; some efficiency gains but often offset by new layers of complexity elsewhere in NHS structures.

Without parallel initiatives to streamline administrative processes, improve efficiency, and enhance clinical productivity, such structural changes to NHS England and ICBs alone will not significantly improve frontline clinical care or health outcomes. Administrative costs, while important to minimise, make up a relatively small proportion of the overall NHS budget. Genuine productivity gains will therefore require systematic reforms aimed at reducing unnecessary bureaucracy and optimising workforce deployment, alongside strategically investing in information technology and process improvements.

Reference

Majeed A. Abolishing NHS England will make only modest savings. BMJ 2025; 389 :r788 doi:10.1136/bmj.r788