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55 End of life care for expected deaths in prison custody: a service evaluation of current practice in five prisons in the North of England mapped to the dying well in custody charter
  1. Hannah Billett and
  2. Joanne Thomas
  1. Health Education England North East, Spectrum Community Health CIC


Background Deaths from natural causes are increasing in prison populations. The 2018 Dying Well in Custody Charter (DWCC)1 aims to support delivery of holistic and individualised care for those dying in prison custody. We recognised the need to review expected prison deaths to better understand current practice and guide improvement.

Method A retrospective electronic notes review was performed for all expected prisoner deaths, within five prisons in northern England, across the calendar year of 2020. The DWCC Self-Assessment tool2 was used to create ten assessment standards for use in this project. These were directly mapped to the DWCC ambitions. Data collected included evidence of multi-disciplinary team (MDT) working and advance care planning (ACP), documented DNACPR discussions, identification of dying and anticipatory medication prescribing.

Results Fourteen patients met inclusion criteria. 79% of deaths were due to cancer. 21% died in hospital and 79% died in prison. All had a DNACPR form in place. ACP occurred in 92.8%. Early release on compassionate grounds was considered in 79%. 86% had evidence of holistic needs assessment. Recognition of dying was documented in 57% and occurred between 7 hours to 1 month before death. 85.7% had some form of anticipatory medications prescribed. Palliative Care services provided support in 93%.

Conclusions Areas of good practice include engagement in ACP, DNACPR decision making and utilisation of palliative care services. Security and legal considerations were thoroughly and carefully considered. There were numerous examples of individualised care and collaborative MDT working in complex circumstances. Supporting skill development in recognition of dying and anticipatory prescribing were identified as areas for improvement. Despite the small sample size we believe this service evaluation provides an important snapshot of how patients are dying in prison custody. By sharing these experiences we hope to better support the delivery of holistic care in this setting.


  1. Dying Well in Custody Charter, A National Framework for Local Action. Ambitions for Palliative and End of Life Care Partnership. Published April 2018.

  2. Dying Well in Custody Charter, Self-Assessment Tool, A National Framework for Local Action. Ambitions for Palliative and End of Life Care Partnership. April 2018.

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