Providing palliative care for prisoners - a hospice perspective Dr Rachel Kemp Medical Director Marie Curie Hospice Edinburgh

Setting the scene Marie Curie Hospice Edinburgh Offers both in-patient and community services HMP Edinburgh in hospice catchment area 6 patients between 2013 and 2017, 5 of whom died in the hospice Autumn 2017 - particularly challenging experience of providing end of life care for a prisoner in the hospice Catalyst for creative and innovative partnership

Practical challenges Previously, referrals to palliative care have been reactive rather than proactive. Late identification and lack of planning results in fire fighting when the crisis happens. When to provide palliative care in prison vs. when to transfer to hospice unit? Risk assessments – who makes them and how are they shared? The right time for compassionate release?

Challenges for the hospice Informing and supporting our staff Protecting prisoner confidentiality vs. informing staff of potential risk Availability of information in the public domain – the power of Google! Supporting staff anxiety and fear Limited awareness of hospice/prison facilities and what is possible Managing the media circus and impact on charity reputation

Challenges for the prison Who is palliative? Is end of life care possible or desirable in the prison? Sharing of information between SPS staff and health care team Overnight availability of health and social care 24/7 access to medicines Emotional impact of looking after someone who is unwell/dying

Working in partnership, moving forward together Key staff from prison and hospice setting have quarterly joint meetings Clinical engagement with emphasis on proactive approach, early identification and planning Hospice CNS attends monthly prison health care team meetings Palliative care register established –SPICT/ traffic light system Hospice staff involved in DIPLAR meetings Hospice PFST have offered bereavement support to prison officer following distressing death of prisoner Plans in place to support 24/7 access to medication in prison setting Additional nursing and health care assistant hands on support from hospice? ‘To Absent Friends’ event in HMP Edinburgh

Moving forward together Educational sessions, visits and shadowing opportunities for staff 50 hospice staff have visited the prison Hospice staff have delivered ‘toolbox talks’ for SPS staff Education and support for prison health care team Link’ staff / ‘champions’ identified in both prison and hospice settings Educational lunchtime sessions for hospice staff Prison staff and prisoners getting involved in fundraising opportunities Representation on Palliative Care in Prisons national steering group The future is exciting – enthusiasm exists and opportunity awaits

‘If these officers can carry out their role without judgement or prejudice, then that is something we should strive for at the hospice. I know people find this difficult to do, however, every individual is entitled to respectful, dignified end of life care’