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

2. 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 particularly challenging experience of providing end of life care for a prisoner in the hospice
Catalyst for creative and innovative partnership

3. 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?

4. 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

5. 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

6. 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

7. 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

8. ‘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’