The Nuffield Trust research, which explores 15 jurisdictions across the world where assisted dying is legal, finds the complexity of establishing this system infrastructure necessitates 'substantial lead time'.

The Nuffield Trust finds that building the capacity for assisted dying has been a significant and ongoing challenge in many countries. Estimates of funding within the UK government's impact assessment are limited to direct costs - for example, for staff directly involved. However, international evidence demonstrates that wider costs need to be considered, to develop the infrastructure to support implementation of assisted dying services.

Across all jurisdictions that have legalised assisted dying, the proportion of assisted deaths has increased over time, even when eligibility criteria have not changed. The Nuffield Trust research finds policymakers in the UK need to consider that assisted dying would place added pressure on NHS, hospice and social care capacity — both because managers and organisations will have a substantial task implementing the policy, and because of the staff time, space and resources needed to meet rising demand for it.

The research reveals that almost all jurisdictions produce formal assisted dying reports, usually annually. Demographic data about individuals enable countries to monitor access and identify service gaps, which are often a serious concern with respect to equity and safeguards.

In addition, the research suggests that healthcare providers must be able to step away from particular cases that cause them moral distress, otherwise they become reluctant to be involved in assisted dying at all.

The Nuffield Trust recommends that policymakers in the UK should:

• anticipate that if assisted dying is legalised, there will need to be a range of new infrastructure and services required, covering activities such as regulation, training and data management
• be ready for regulation and oversight functions to expand as more people request assisted dying over time, and if requirements change
• establish a system to pay providers for assisted dying. This will need to account for the combination of charitable and public funding for end of life care, and also payment for independent contractors
• consider specific support for staff who have religious or other objections to assisted dying
•  underpin new processes for assisted dying with digital infrastructure, to streamline administrative processes and improve data collection
• carefully monitor assisted dying implementation by ethnic group, sex, region and other characteristics.

Nuffield Trust deputy director of research, Sarah Scobie, said: 'With assisted dying remaining a contested issue, and our health and care systems struggling under immense pressure, implementing a new service won't be straightforward. However, other countries provide valuable lessons which can help policy makers to make good choices as the bills legalising assisted dying continue their parliamentary journeys.

'Much of the UK debate around assisted dying so far has focused on avoiding a slippery slope towards misuse of the service, but many people in other countries face barriers to accessing assisted dying. If parliamentarians choose to legalise it, they will need to get the balance right and worry not just about people who have an assisted death when they shouldn't, but also about people who can't when they are meant to be eligible.'