A project to improve end-of-life care for prisoners at HMP Isle of Wight has been shortlisted for two top national awards.
The inpatient healthcare unit within the prison is run by independent health and social care provider, Care UK, and an initiative introduced by the organisation to improve end-of-life care has been shortlisted in this year’s Patient Safety and Care Awards and the Laing Buisson Independent Healthcare Awards.
Dr Sarah Bromley, national medical director for Care UK’s offender health services, submitted the project, called Not Dying in Chains, and is delighted it has been shortlisted for two awards. She said: “The thought of dying in prison is something that terrifies many prisoners. Dying in a hospice or hospital flanked by prison guards, often still chained, is a death without dignity. Furthermore, since the cost of providing prison officers for escorting prisoners to appointments and whilst in hospital amounts to around £1,000 per day, hospital care for prisoners can be extremely expensive.”
HMP Isle of Wight has an in-patient healthcare unit (IHU), staffed 24 hours a day by the nursing team, along with two primary care departments. In 2009 the team were successful in securing a King’s Fund Grant under the Enhancing the Healing Environment programme. This enabled the development of two enhanced cells and a private garden providing a quiet space for relaxation and reflection. Prisoners were involved in all stages of the project, particularly the design and building of the garden.
The clinical team worked alongside the local palliative care team to make improvements to the end of life care offered, locally adapting community policies and pathways to suit the prison environment. Over time this care has been subject to a process of continuous development to suit the needs of the prisoners and ensure that learning is taken from every case and used to make improvements for the future.
Key improvements and initiatives include:
- Prisoners are offered an overnight stay in the IHU following an initial diagnosis of a serious or terminal illness with counselling and support offered as required.
- A weekly support group for patients with terminal illnesses on the IHU, facilitated by a lead nurse, and is open to prisoners on wings who are brought over to the IHU for the group.
- A visit to the IHU is offered to patients who may need end of life care to show them the environments, dispel any myths or rumours they may have heard about the unit and to enable them to understand what is on offer.
- A system is in place in the primary care units enabling fast track access to appointments with nursing staff and GPs thus ensuring patients are seen in a timely manner.
- A monthly Gold Standard Framework meeting; a multidisciplinary meeting involving GPs, nursing and the mental health team, pharmacist, ‘in-reach’ Macmillan nurses and representatives from the wider prison including chaplaincy and prison employees where the patient is happy for this. These meetings have currently been used to discuss those with a cancer diagnosis but are being extended across all conditions likely to be terminal. In this meeting care plans are discussed to ensure all colleagues understand and follow the plan and that patient choices are taken into account, including flagging when a DNA CPR form has been signed. In addition to this the potential for compassionate release is discussed.
- Work has been undertaken with the local hospice to agree an integrated care plan for the final days of life, ensuring that care is at least equivalent to that provided in the community.
In May 2012 an HMIP (Her Majesty’s Inspector of Prisons) inspection concluded that ‘there were good care arrangements for men with palliative care needs’ at HMP Isle of Wight. Similarly the service has been commended by the Care Quality Commission (CQC) and the Kings Fund report, Enhancing the Healing Environment for End of Life Care.
The team at HMP Isle of Wight have been sharing their work with other prisons in order to share best practice, and have taken learning from work done in the North East prison cluster who deliver nationally acclaimed end of life care services.
The award ceremonies will take place in July for the Patient Safety and Care Awards and in October for the Laing Buisson Independent Healthcare Awards.