Assisted dying Bill costings ‘not sufficiently comprehensive’, says committee

Cost estimates for legislation on assisted dying are “not sufficiently comprehensive”, a Holyrood committee has said.

The Finance and Public Administration Committee at the Scottish Parliament is tasked with assessing the financial memorandums (FMs) of new Bills.

In a letter from the Health, Social Care and Sport Committee, convener Kenneth Gibson raised concerns about the costings for the Assisted Dying for Terminally Ill Adults (Scotland) Bill.

The legislation, tabled by Liberal Democrat MSP Liam McArthur, would allow Scots with a terminal illness to take the decision to end their lives after the approval of two different clinicians.

A letter sent to the committee from McArthur put costs in the first year of the legislation being in force at “between £263,434 and £313,882, and ongoing costs rising year-on-year from between £23,107 and £35,566 in year two, to between £160,186 and £368,954 in year 20”.

However, in his letter on Thursday, the convener raised concerns about the costs, saying stakeholders claimed the comparisons used—from systems in Oregon in the United States and from the state of Victoria in Australia—were not correct and that the Canadian model would be a better comparison.

A submission to the committee from a representative of the group Living and Dying Well – which is opposed to the legislation – claims the number of people who would seek assisted dying has been underestimated and would be between 170 and 180 in the first year, rising to between 780 and 790 in the third, and would “continue to rise steeply” when compared to figures in Canada and adjusted for population.

McArthur estimates just 25 people would use the process in the first year, rising to 400 annually after year 20.

The convener said: “The committee is concerned that initial demand and therefore costs may be significantly higher than anticipated given the likely significant rise in public awareness around assisted dying as a result of the wider debate in Scotland and the UK around the respective Bills under consideration, and the lack of timescales attached to life expectancy in the Bill as introduced.”

The committee also questioned the savings to the health and social care budget which could result from the legislation.

McArthur did not indicate in his costings the savings to be made, saying it was “not the policy aim of the Bill”.

But the convener said: “Standing orders require details on potential savings to be provided in all FMs, alongside cost estimates and other changes to revenues arising from the provisions in the Bill.

“We therefore conclude that estimated savings such as medical and social care should have been included in the FM and suggest that these are now provided to inform future consideration.”

A written submission from the Royal Pharmaceutical Society Scotland also questioned the price of the drugs required for a person to end their lives, suggesting the £80 per dose quoted could be a “huge under-estimate”.

Responding to the letter from the committee, McArthur said: “As the Finance Committee have acknowledged, depending on which assumptions are made, one could estimate the cost to be higher than the memorandum does, or indeed to be lower.

“No-one can know for certain exactly how many people might wish to have an assisted death, but evidence shows that in places with a similar law assisted dying comprises less than 1% of all deaths.

“I would question the committee’s decision to give weight to the claim that Canada is the appropriate comparator.

“My estimates are based on case numbers in the state of Oregon in the United States, and the state of Victoria in Australia, which have similar models to the one I am seeking to implement.

“Canada has a very different model for assisted dying, with very different case numbers and associated costs.

“Similarly, as I explained to the committee, it is not possible to provide a reliable estimate of potential savings, because there are variations in existing types of end-of-life care and costs, which mean this data does not exist.

“I wish to be crystal clear that the intention of this Bill is not to make savings but to provide dying people with the choice they need and put in safety measures that protect everyone.

“It should be borne in mind, however, that in other jurisdictions that have legislated on a similar basis we have seen additional investment directed towards palliative care.

“I remain confident that the assumptions and methodology used in the memorandum is evidence based, that they reflect a justified midpoint of the extremes of opinion, and that they provide a reasonable estimate of likely numbers and costs.”