Background The UK prison population is growing older and sicker with deaths from natural causes increasing by 77% in the last 10 years (Hospice UK. Dying behind bars – How can we better support people in prison at the end of life? 2021). Those in prison are identified as at risk of experiencing poorer end of life care (Care Quality Commission. A different ending: end of life care review. 2016). Our hospice catchment area includes a prison accommodating 1200 men.
Aims This service evaluation aimed to develop the hospice input to the local prison, improving communication and support for prison healthcare staff. Whilst patients were referred historically, expertise was held by a sole clinician who subsequently left the team.
Methods Data was analysed for all patients referred from July 2021 to the present. Attendance at a weekly virtual prison MDT commenced in November 2022 to improve communication.
Results From July 2021 – March 2022 no referrals were received. In the last year referrals have steadily increased; a consultant and specialist paramedic practitioner have been assigned to lead on the service and attendance at a virtual MDT established. 7 patients in prison have been supported with an average age of 61yrs (n=47–75). Diagnoses include cancer (n=5), CVA (n=1) and end stage renal failure (n=1). 8 prison visits, with 22 face-to-face encounters, and 14 MDTs have occurred. Hospice input has involved symptom control advice, explanation of test results and treatment; advance care planning; applications for compassionate release and bereavement support. 6/8 visits have been done jointly and a hospice policy written to allow knowledge gained to be held and shared by the wider team.
Conclusion Commitment to the virtual MDT strengthened communication and relationships with prison healthcare staff and improved care for patients. Designating two clinicians to lead the service ensured continuity and momentum to successfully re-establish the service, whilst policy writing and joint visits across the team has allowed the growth of knowledge and expertise within our organisation.
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