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Excellence in Nursing case study: Gill Scott, Macmillan Prison Project CNS Lead

The Macmillan End of Life Prison Project delivers high quality palliative and end of life care services in a challenging environment.

Gill Scott: Macmillan Prison Project CNS Lead, County Durham and Darlington Foundation Trust.

Gill-Scott

The Macmillan End of Life Prison Project delivers high quality palliative and end of life care services in a challenging environment. In addition death in custody has been actively discouraged by prison staff as it incurs complex prison police and legal proceedings Delivering high quality end of life care within a prison community is complicated by the nature and culture of this challenging and sometimes chaotic environment. Not only is there a tension between care, security and discipline but the nature of prison facilities, resources available and the lack of staff skills understanding and knowledge in this area of care.

Gill brought together the North East Offender Health Commissioning Unit, Macmillan Cancer Support, the North East Strategic Health Authority, County Durham and Darlington Community health services (and Care UK) to develop a robust service to address the inequity in service provision for offenders and their families with cancer palliative and EOLC needs. Current partners now additionally include Care UK (healthcare providers prisons), prison discipline staff and prisoner groups.

In 2007 the Macmillan team were involved in embedding the KITE standards for cancer and end of life care into General Practice (a managed system of care equivalent to the Gold Standards Framework). It was clear the standards did not fit with the prison context and that a bespoke approach combined with better integration and co-ordination of the services available within and outside the prison was needed to benefit patients with end of life care needs.

The Macmillan Prison Project Team work collaboratively together with prison health care and discipline staff to benchmark performance, develop action plans, develop tools systems and processes. This collaborative working has achieved the following:

  • Series of prisoner focus groups to ascertain concerns/ questions about end of life care
  • Development of 28 Standards for palliative and end of life care in prisons
  • Development of associated tools/ protocols/ pathways to support care delivery
  • Engagement with relevant health and discipline professionals
  • Production of a DVD based on the questions and concerns raised by prisoners
  • Delivery of accredited and non accredited education and training.

The impact this partnership has achieved is significant on people affected by cancer and strategically by:

  • All expected deaths in Durham prison cluster have been managed within the respective prisons, with all patients on the prison palliative care register, had key worker/ holistic assessment
  • Opportunities to undertake advance care planning and care at the end of life beingguided by adapted end of life care pathway (been cared for on the end of life care pathway)
  • Macmillan adoption of standards as a tool of best practice nationally
  • Positive ombudsmen reports on all expected deaths
  • Positive working relationships with Macmillan Cancer Support, North East Offender Health commissioners/ prison staff/ groups
  • National and regional profile
  • Participation in national conference                                       
  • Project won an international nursing award.

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