I am a palliative care doctor who is not opposed to AD.

But on the eve of tomorrow's vote, it boils down to this.

Enshrining in law a state-funded right to die, while not enshrine a similar right to the palliative care that might make life worth living, is deeply wrong. 🧵 It means people will end their lives under the guise of "choice", while denied the care that could have given the hope, comfort & meaning they needed to want to live.

Choice is only free when there are genuine alternatives to choose from.

Otherwise, it's a libertarian charade.

Dismayed to see you sharing such a misleading & potentially deeply frightening video, Kim.

If someone is in 'unspeakable pain' at the end of life, they should see a palliative care doctor like me - & I can promise you there is always something I can do for your pain. (1/n) If they don't see a palliative care doctor like me - because we are such an appallingly under-resourced service (if only the committee cared as much about *this* issue as they do AD) - then that person is being failed unforgivably. They are not receiving appropriate care. (2/n)

🧵/ This heartbreaking case highlights why so many doctors like me have begged @NHSEngland & @DHSCgovuk to stop endangering NHS patients by substituting doctors with non-medically trained PAs

We've been dismissed & smeared as "toxic bullies".

Please read this thread & decide. When Pauline Marking, 77, started vomiting blood & went to A&E in severe abdominal pain, her family had no idea she was treated by a PA, not a doctor.

The PA independently treated & discharged Pauline, with no doctor oversight.

They diagnosed her as having a nosebleed.

We need facts as never before.

3 years after Putin invaded Ukraine, I spent 24 hours with combat medics on the Ukrainian frontline.

Their courage, compassion, dedication & skill are astounding.

Please read (@guardian link below) & please never stop standing up for Ukraine 🇺🇦 This is Viktoriia Kovach, former obstetrician, now Chief Medical Officer of the Third Assault Brigade. She told me how Russian troops violate the Geneva Conventions, targeting doctors & patients:

"If a medical team tries to evacuate them, they will be hunted and killed, too.”

🧵/ I agonised over whether to write this piece in today's Sunday Times.

Whipped-up emotion, hate & vitriol now dominate discussions of assisted dying on here - appallingly.

We have to be able to converse in good faith - & concerns should not be dismissed as "noise". (1/n)
I was honoured, daunted & apprehensive about being called to give evidence to Kim Leadbeater's bill committee.

I am not anti assisted dying at all. But - based on my years of experience in palliative care - I am painfully aware of the need to get the safeguards right. (2/n)

Thread/

Today, a devastating report from the @theRCN, based on the testimony of over 5000 NHS nurses, has rightly catapulted the national shame that is NHS 'corridor care' into the headlines once more. (1/n) This winter, nurses describe being forced to give care in corridors, cupboards, toilets, car parks & hospital gyms on a daily basis – locations without lifesaving equipment such as oxygen & bedside monitors, meaning that patients are “routinely coming to harm” or dying. (2/n)

Misleadingingly contextualised piece, @NickTriggle, which relies, predictably enough, on those infamous anonymous NHS senior sources.

The crux of the issue is not, as you claim, 'the speed at which [PAs] are being recruited". 1/n

bbc.co.uk/news/articles/… Rather, it is the replacement of doctors with PAs in multiple different safety-critical settings, despite their radically shorter & more superficial training (a 2 year course, not a 5 year medical degree; no post-grad medical training). 2/n

What troubles me most about ⁦@kimleadbeater⁩’s bill is that it places a legal obligation on the Secretary of State to ensure that assisted dying is available to patients for whom he’s under no such duty to provide adequate palliative care. 🧵 bills.parliament.uk/bills/3774/pub… Her bill, she says, has world-beating safeguards to prevent coercion of vulnerable patients to end their lives prematurely.

But “existing palliative care provision” is not “excellent” as she claims. Far from it. We are desperately underfunded & struggle to meet patients’ needs.

🧵 This week - under a Labour government - NHS community services for the entire population of Wilshire (half a million people), were handed to a private equity backed company, @HCRGCareGroup, formerly known as VirginCare. 1/n A consortium of NHS, local authority & charities also made a bid to run the community services - as they were already doing. But no, the contract was awarded to an outfit whose owners celebrate realising 'significant tangible wealth' via, for example, 'corporate carve-outs'. 2/n

🧵/

This is, I believe, unprecedented in the history of UK medicine.

28 eminent UK doctors have written publicly to @LaylaMoran, the new chair of @CommonsHealth, to report something nothing less than scandalous.

Read their letter here (1/n) 👇

bmj.com/content/386/bm… The signatories, all Fellows of @RCPhysicians, believe that their College, the @gmcuk & @DHSCgovuk essentially colluded to mislead parliament in claiming that the College approved legislation going through Parliament this year to regulate physician associates (PAs).

(2/n)

I’m simply horrified to see @NHSEngland now literally breaking the law in how it misrepresents physician associates & other allied health professional - who are NOT doctors - to the public.

These posters are from the Bradford District & Craven Health & Care Partnership. 1/n

I downloaded the posters from their website, here:

“Physician” is a title that’s protected in law - to protect you, the public, from the dangers of fake doctors masquerading as the real thing. 2/nbdcpartnership.co.uk/download/96/gp…

Well, I’ve read the @Conservatives manifesto on health so you don’t have to.

Aside from the expected unfunded nonsense on those 40 fictitious new hospitals, cutting managers & using AI to ‘free up’ doctors & nurses etc, here’s a stand out out example of its vacuousness. 🧵 What even is this verbiage? A ‘plan’ to prevent cancer from occurring, but also to give patients the best possible care? When over 235,000 cancer patients have had their treatment delayed in the last 3 years?

Come on, @Conservatives, this is offensive.

BREAKING/

This is a scandalous moment in UK medicine.

Over 80 Fellows of @RCPhysicians have just declared their lack of confidence in the College.

Why?

Because they believe its stance on physician associates (PAs) is recklessly failing patients.

Pls read - this matters. 🧵 The Fellows - over a quarter of whom are professors - are appalled by @RCPhysicians' role in in enabling the government's project of replacing doctors with cheaper & less well-trained doctor substitutes (PAs) in an extraordinary array of medical jobs across the NHS.

The GMC have tweeted this in response to widespread alarm from doctors at a video showing an 'AA' (anaesthetic associate) openly bragging about using "local governance" to get away with less supervision by doctors.

I find the GMC's position deeply concerning.

Here's why. 🧵

https://twitter.com/gmcuk/status/1795822703624028178

The video in question was recorded at a GMC conference in 2022.

AAs, like PAs (physician associates), are not doctors.

They have neither a medical degree nor anything like the depth & breadth of doctors’ training, yet are being used increasingly as doctor substitutes.

Astonished to see @timspector doubling down on his reckless comments re: boosting 'cancer immunity' by stopping using SPF year round.

The study on which he bases his claim is in mice, not humans - & one of the study's own authors has publicly disputed Spector's conclusions. 1/3 As a doctor, how can he possibly imply we should use less sunscreen in order to reduce cancer risk?

Vit D deficiency from lack of sunshine can be addressed by diet.

But fatal skin cancers, as I know all too well in palliative medicine, cannot. 2/3

🧵 Whatever your views on assisted dying, one thing I’d hoped we’d all agree on is that the topic is ethically fraught & complex.

Not so Matthew Parris.

For him, it’s simple. Old & frail people *should* be killed - to save society the cost of looking after them. 1/n In no sense am I twisting Parris’s words.

Here he rehearses an argument often used by opponents of AD to fight legal change - that with time, it will lead to people feeling pressured to end their lives prematurely (for it would be socially irresponsible of them not to). 2/n

Dear 🇬🇧,

The current state of UK medicine - a brief 🧵

Exactly 1 week ago, I felt I had no choice but to resign from giving a keynote speech at this year's @RCPhysicians annual conference.

The behaviour of the College leadership left me no choice. 1/n

https://twitter.com/doctor_oxford/status/1768180726732620165

The @RCPhysicians had been forced by its Fellows to hold an Extraordinary General Meeting - the third ever held in its >500 year history.

Fellows were appalled at the College's key role in driving through the government's plans to replace doctors with cheaper substitutes. 2/n

Dear UK public,

Yesterday, hot on the heels of widespread concern among doctors at the govt’s project of replacing NHS doctors with doctor substitutes, @gmcuk released a blog about its future intentions.

It left doctors like me reeling.

Here's why 🧵

gmcuk.wordpress.com/2024/03/12/dev…
@gmcuk First, a reminder of what the GMC is.

Founded 166 years ago, the GMC protects the public by maintaining a register of drs in the UK, controlling entry to the register & suspending or erasing members if necessary.

It sets standards for all UK doctors.

Weighty, vital stuff. 2/n

Dear 🇬🇧,

Please read - this NHS scandal potentially affects you all.

🧵 Having studied the data, just released, from the @RCPhysicians members' survey on PAs, I couldn't be more disgusted by the lack of probity, honesty & fairness of those who lead my Royal College. 1/n Last week, @RCPhysicians leaders were forced, against their will, by members & fellows to hold an extraordinary general meeting: only the 3rd in the Royal College's >500 year history. 2/n

🧵 Doctors are depressingly used to being smeared by govt ministers.

But likening us to intimidatory "drug dealers" is a new low from @JimBethell.

He's trying to delegitimise our genuine patient safety concerns about @DHSCgovuk's roll out of PAs as doctor substitutes. 1/n

https://twitter.com/JimBethell/status/1766153034353021286

The crux of the issue is this.

The government (reasonably enough) looked at ways of reducing the NHS staff bill.

Physicians assistants - less qualified & cheaper than doctors - would assist doctors in admin/straightforward tasks, freeing them up for more complex work. 2/n

"Staff members were buying rain ponchos from Amazon because they offered better protection than what we had."

Please read this devastating interview with Dr Nathalie Macdermott, who caught Covid after being denied PPE by her hospital. 1/3
thesun.co.uk/tv/26011843/br… Nathalie, a former runner, is so severely disabled by Long Covid, she has to use a mobility scooter.

Like so many NHS staff, she was treated like cannon fodder - even as the government told the public (dishonestly) there were no problems with PPE supplies.

It's scandalous. 2/3