Tuesday 29th September 2015
Mac Voice, the magazine for Macmillan professionals: Autumn 2015
Lorraine McBride, Macmillan project lead for palliative and end of life care in prisons since January 2015, talks to us about her role at Compton Hospice, Wolverhampton
What does your current role involve?
I work with prison teams and prisoners at Her Majesty’s Prison Oakwood to improve access to palliative, end of life care and cancer services. I provide advice and support to healthcare staff, prison officers, the senior prison management team and anyone employed by the prison establishment. I assess the needs of all staff in relation to these issues for male prisoners. My aim is to increase awareness of symptoms of cancer with prisoners so that we can achieve better outcomes or support those who require palliative care.
What is your background in cancer care?
I have worked in cancer and palliative care services since 1994. I was a chemotherapy nurse for 11 years, during which time I became the senior manager of Stafford Hospital chemotherapy day treatment unit. In early 2006, I moved to Walsall NHS Trust where I spent three years working as a Macmillan lung cancer nurse specialist. Following that, I worked as a palliative care nurse specialist for almost two years at Sandwell Primary Care Trust and in 2010 I joined the specialist palliative care community team at Compton Hospice.
What attracted you to this role?
The fact that I was going to work with one of the most disadvantaged groups in the country. There is no generally agreed pathway for palliative and end of life care for prisoners. Prisoners are not often mentioned in national documents relating to cancer, palliative care or end of life care. If they are, it is usually in a short section relating to all the disadvantaged groups. There have been a couple of key documents produced which are specifically about the needs of prisoners.,[1, 2] The content of these documents and the work I was undertaking as a Macmillan CNS encouraged me to apply for this role.
Why is it important for people in prison to have access to end of life care?
Any person has the human right to be free from torture and cruel and unusual punishment. Prisoners have the right to access healthcare, including palliative care and essential pain medication. The requirement for palliative and end of life care in the prison population is unlikely to reduce in the future, so there is a need to ensure adequate provision for delivery of this care.
How do you make a difference for prisoners affected by cancer?
I work with the healthcare and support helpline group – a group of prisoners who provide a helpline for other prisoners within the prison. This is a service that is not available in many prisons. I also meet with various prisoner user groups who then talk to other prisoners to inform them of the ongoing support available from the healthcare team and the prison officers.
By working with prison teams and prisoners, we can improve access to cancer and palliative care services by highlighting common cancer symptoms to be aware of. If more people are aware of what to look for, we may achieve better long-term outcomes.
If this project is successful, it may also be implemented in HMP Featherstone and HMP Young Offenders Institute Brinsford during 2016.
What are the difficulties that are unique to your role?
The main difficulty is that prisoners are not told when they have hospital appointments and their families cannot be informed. Therefore a prisoner will not have the support they may require when receiving bad news or important results.
There are also some issues with prisoners wanting to seem strong and often being reluctant to acknowledge symptoms they may have. If these prisoners were at home, they may have someone who would encourage them to see a GP.
Many of the prisoners may not have engaged with healthcare services when they were out of prison, so there are often multiple long-term conditions which can be difficult to assess.
What are the rewards of your role?
I am able to support prisoners and prison staff to cope with cancer and other illnesses that are not going to improve. There tends to be a general feeling within the public that prisoners deserve what they get but I, Macmillan and the hospice believe that everyone has a right to achieve the best possible life and death. By supporting prisons, we can go some way to achieving this within the limits of caring in a prison environment.
Macmillan has also supported me to work on my master’s degree in health sciences (palliative care). This has enabled me to utilise and further develop my knowledge, skills and practice within this exciting project.
Macmillan has an information booklet called Dying: a guide for prisoners with cancer in England and Wales. Order or download the booklet from be.Macmillan.
1. Prisons and Probation Ombudsman for England and Wales. Learning from PPO investigations: end of life care. 2013.
2. The National End of Life Care Programme. The route to success in end of life care – achieving quality in prisons and for prisoners. 2011.
3. United Nations Office on Drugs and Crimes (UNODC). Handbook on prisoners with special needs. 2009.