Next Friday’s vote on assisted dying has left many MPs facing a major dilemma. While some have long-standing and deeply held views on the issue, others do not. These waverers are listening carefully to all sides and grappling with their consciences; many have still not decided how to vote. They are trying to resolve the question of how to balance the right of a terminally ill person to decide when their life comes to an end with the worry that some people in this position might be unduly pressured into agreeing to die earlier than they would like. It is the sort of intractable and emotive ethical dilemma that we elect politicians to resolve on our behalf.
Yet as the vote nears, it is not only moral problems that are rearing their heads, but political ones too. The divisions and tensions that the issue has caused within the Government risk spilling over and causing a major headache for Sir Keir Starmer.
The Prime Minister decided early on to follow the tradition of not telling MPs how to vote on ethical issues such as this: MPs will be allowed to follow their consciences, not their party whips. But what to do about Cabinet ministers? Could a new government trying to cement its authority afford to have its top team publicly arguing with each other on the matter of euthanasia? Worried that such an unedifying row that would make the Government look hopelessly disunited, Starmer and his team decided that no, it couldn’t. And so Simon Case, the Cabinet Secretary, was ordered to tell Cabinet ministers that their views should be kept largely private.
It was a ridiculous idea from the start. Were ministers supposed to hide their views from their constituents? Should they refuse to answer questions on such an important and contentious issue? Realising that this was impossible, Case told Cabinet ministers that they “need not resile from previously stated views when asked directly about them” but “should not take part in the public debate” – as if those demands were not wildly contradictory. Any senior member of the Government expressing an opinion on the matter would inevitably be seen as taking part in the public debate.
While the approach was fundamentally flawed, one Cabinet minister has gone further than others in pushing the boundaries of the diktat. Wes Streeting, the Health Secretary, has emerged as one of the most vocal opponents of legalising assisted dying. He initially voiced concerns at a private meeting of Labour MPs, saying he did not think the quality of palliative care was currently good enough for patients to make a free choice.
But it was his comments in public last week that most angered his opponents on the issue. Streeting let it be known that he believed spending money on assisted dying would mean the NHS having to make cuts in other areas. While few sought to actually engage with his argument, critics accused the Health Secretary of using his platform to try to harden opinion against changing the law.
It isn’t just Labour MPs or fellow ministers that are frustrated – Starmer’s team is also running out of patience with what some see as a clear flouting of Case’s instructions. Part of the reason his comments have gone down badly in Downing Street is that he is arguing, indirectly, against the Prime Minister. Starmer has long been a keen advocate of legalising assisted dying. Would Streeting have faced such ire had he been echoing Starmer’s view rather than opposing it? Almost certainly not.
What his critics ignore is that, on this issue, Streeting is not just another member of the Cabinet. His role means he has more insight than most in Westminster into the practical consequences of allowing assisted dying. He runs the department that would be tasked with implementing it. It is completely reasonable, therefore, that his views should be given careful attention in this debate. As an MP his vote counts for no more than any other’s. But as the Health Secretary, should his voice not be heard more loudly when it comes to the issue of how doctors approach terminal illness than, say, the Energy Secretary or the Transport Secretary?
Just imagine the alternative. The current Health Secretary has serious concerns about the impact that a major proposed change in the law will have on the health service, and yet is barred from saying so publicly. Is that what is supposed to happen? Well yes, actually – according to some of his Cabinet colleagues at least.
Asked yesterday about Streeting’s comments, Education Secretary Bridget Philipson said it was “usually best if those discussions [about the impact of changing the law] are done behind the scenes”. In other words, MPs should be asked to vote on a change that might have significant consequences for the NHS, without being made aware of what those consequences are. What a ridiculous suggestion.
Perhaps the grumbles about Streeting from some of his colleagues can be explained by something else: envy. Streeting is a confident politician who knows what he thinks and says what he means. His straight-talking, robust approach occasionally ruffles feathers but stands out for the right reasons when some other ministers are sent out to utter endless banalities and furiously do their best not to answer a single question. Indeed, Streeting’s reputation as one of Labour’s best communicators is why Downing Street sends him out to do interviews with a regularity that bothers some of his more experienced – and less visible – colleagues.
The Health Secretary has also proven to be effective behind the scenes, ending the NHS strikes within weeks and energetically pursuing a bold programme of reform. In last month’s Budget, he secured over £25bn of investment for the health service – the biggest cash boost since 2010 – while other government departments saw their pleas for more cash largely rejected. Streeting has been unafraid to demand that this money is accompanied by improvements, modernisation and efficiency changes from health services leaders. He has shown a commendable willingness to take on some of the interest groups that seek to defend the status quo.
While he has a better early track record than many of his Cabinet colleagues, Streeting’s strengths also pose a challenge for Keir Starmer. The Prime Minister must find a way to manage a team that includes forthright, assured politicians who know their own minds and are unafraid to fight their corner. These star players generally make the best Cabinet ministers, but they can disrupt the team and threaten the authority of Downing Street, as Streeting is accused of doing on the issue of assisted dying. Desperate to avoid this, some recent prime ministers have preferred to surround themselves with fawners, hangers-on and cronies. They have side-lined those they feel might threaten their authority, dispatching political big beasts to the backbenches where they can cause waves but not rock the boat from within.
That is not Starmer’s style, and nor should it be. This Government needs strong, decisive and capable Cabinet ministers willing and able to deliver the change that Labour promised and adept at communicating effectively with voters about the progress they are making. It is not clear whether all of those currently around the Cabinet table fit the bill, but Streeting has shown that he does. Rather than sniping about his boldness, No 10 should recognise that this is precisely what they need more of.
If the Health Secretary’s forthrightness angers some of his colleagues, it is in no small part because they feel threatened by it. By voicing his concerns about the impact that legalising assisted dying might have on the NHS, the Health Secretary is doing his job and doing it well.
It is no great surprise that those on the other side of the argument dislike how Streeting is making his case. But rather than moaning about the man, they should try and engage with his arguments. The country needs its senior politicians to have a serious, robust and considered debate on an issue as important as this. Those focusing on who is saying what, rather than engaging with what is actually being said, are doing the country a disservice.
Ben Kentish presents his LBC show from Monday to Friday at 10pm, and is former Westminster editor
