Living Dying Well in Prison Jayne Miller Service

Living & Dying Well in Prison Jayne Miller – Service Manager Jacqueline Carrigan – Clinical Manager Prison Healthcare

There are currently 3 prisons within the NHS Greater Glasgow & Clyde area: • HMP Barlinnie • HMP Low Moss • HMP Greenock In 2008/2009 Scotland Prison Act (1989) was repealed allowing NHS Boards to become sole healthcare providers for patients held in prisons in their catchment areas and transfer formally took place on 1 st November 2011.

HMP Barlinnie • Scotland's largest and busiest prison • Opened in 1882 and newest hall was built in 1927 • Capacity for 960 BUT frequently holds 1300+ prisoners • Population is all male and over the age of 21 • Mixed population - remand, short term & long term prisoners • Staffing - 1 Health Centre Manager, 3 Clinical Managers, 4 Senior Nurses, 37 Practitioner Nurses, 6 Health Care Assistants & 8 Admin Staff • 80 - 110 admissions per week • Only prison in NHS GG&C to have 24 hour nursing cover

HMP Low Moss • • Re-opened in 2012 but has been a prison since 1968 Capacity for 760 and currently holds 757 Population all male and over the age of 21 Mixed population - remand, short term & long term prisoners • Staffing - 1 Health Centre Manager, 2 Clinical Managers, 5 Senior Nurses, 10 Practitioner Nurses, 7 Health Care Assistants & 4 Admin Staff • 150 admissions per month • Only prison in GG&C that has purpose built disabled access cells

HMP Greenock • • Opened in 1910 Capacity for 249 and currently holds 245 prisoners Mixed population - remand, short term & long term prisoners - all over 21 Staffing - 1 Health Centre Manager, 1 Clinical Manager, 9 Practitioner Nurses, 3 Health Care Assistants & 2 Admin Staff 50 admissions per quarter Only prison in NHS GG&C to have female prisoners – around 50 Just opened 2 CIUs

Prison Healthcare Nursing provision within prisons is split into three "specialities" - Primary Care - Mental Health - Addictions • • Nurse led clinics include - asthma, diabetes, tissue viability, phlebotomy, BBV & depot clinics Routine nursing responsibilities include - admission medicals, risk assessments, triage, medical emergencies & medication administration

Prison Healthcare • Keep Well Services - Sexual Health, Smoking Cessation, Medicine Management • Medical input is via GP's - Mon - Fri, 9 am - 5 pm, preset slots • External services include - Psychiatry, Pharmacy, Dentist, Podiatrist & Optician • Out of hours medical cover is provided via Forensic Medical Examiners (FME's) linked with Police Custody Suite Service • Bid currently in for Psychology

Barriers to providing Healthcare in a Prison setting • • Lack of appropriate accommodation Access to Personal Care Access to Palliative Care Family pressures Prison regime Stigma when attending OP Clinics SPS Compassionate Release Policy

Prison Healthcare A Case Study

Case Study Mr Q • Mr Q is a 52 year old male who was serving a 24 month sentence within the protection hall of HMP Barlinnie • He self referred to Prison Healthcare as he had concerns regarding sudden weight loss and difficulty swallowing • After an initial assessment by the hall nurse Mr Q’s case was discussed with the G. P, he was further reviewed and referred for an Endoscopy

Pathophysiology • Following the Endoscopy, Mr Q was referred to a Specialist Oncologist (Beatson) where he was further assessed (chest x-ray, CT scan and routine bloods). • He was diagnosed with Squamous Cell Carcinoma Oesophageal Cancer with no metastasis • After consideration of the treatment options Mr Q refused all treatment

Past Medical History • Mr Q had no chronic diseases or significant past medical history • He had not been seen by medical staff since his admission to the establishment (12 weeks ago) • He had a history of chronic alcohol dependence, he had received an alcohol withdrawal since admission but had refused any further support from addiction services. • He was a cigarette smoker of approximately 15 -20 roll ups per day and refused referral to smoke cessation services • This was his first custodial sentence

Nursing Assessment • After further consideration and discussions with both nursing and medical staff Mr Q agreed to treatment • Complex case discussion including Mr Q, nursing, medical and the keep well nurse • Formulation of a nursing care plan which involved, planned daily assessment and intervention by healthcare staff • Discussion with wider nursing team and the outpatient nurse from The Beatson

Nursing Interventions • Mr Q attended The Beatson for Radiation Therapy on a daily basis for 14 days • Due to Mucositis / swallowing difficulties Mr Q had a nasogastric tube passed. This was to enable the administration of medication • Mr Q was able to manage a liquid diet and meal supplement drinks • Mr Q was shown how to manage his own NG tube but had challenges with this

Nursing Interventions • Whilst in the establishment, Mr Q received intensive nursing interventions, weekly weights, assessment of NG tube, oral assessment and ongoing emotional support • Administration of prescribed medications • Regular liaison and meetings with relatives and SPS staff • Regular liaison with the outpatient specialist nurse

Liaison with SPS Staff • Mr Q gave us consent to discuss his care with SPS staff to ensure we could request specific medical markers • Liaison with SPS catering, Residential Officers and Escorting Agencies • Liaison with security staff re clinical equipment which was required (glass products) • Planning of appointments and the need for these to be on specific days • SPS considering an application to the Scottish Government for Early Release on Licence on Compassionate Grounds

Outcome • Mr Q completed his treatment and is currently in remission • Mr Q was advised re. positive lifestyle changes and engaged with the Keep Well Service. He had lengthy periods of time with nursing staff which also had a positive effect on his mental state • Mr Q did report symptoms of stress and coping strategies were put in place to enable him to deal with these symptoms • Mr Q continued to smoke during his treatment and when the treatment was completed • Mr Q was transferred to another SPS establishment nearer his home once his treatment was finished

Conclusion • Communication between SPS and NHS can be challenging as we are both considering the healthcare of patients from very different angles • HMP Barlinnie is not an ideal place to provide complex medical care/palliative care. There is a lack of space in the cells, poor light, ventilation issues and the patients regularly find the environment cold. • Despite the challenges we work collaboratively with patients, relatives and wider members of the healthcare team and receive positive feedback