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• The number of older prisoners has increased the need for high quality end of life care, with the prison system now the nation’s largest provider of residential care for frail, older men.
• Report identifies failings, including widespread inappropriate use of restraints, delayed or absent consideration of compassionate release, and care that did not make use of the skills and specialisms available from the health and social care sectors.
• End of life care for imprisoned people should be a UK-wide policy priority.
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A new report by Hospice UK, Dying Behind Bars investigates the increasing need for better end of life care in English prisons, revealing that prisoners are missing out on adequate care at the end of their lives.
The number of incarcerated people aged over 60 has tripled in the past two decades, with approximately 90 percent of older inmates having at least one moderate or severe health complication. Indeed, in the 12 months to June 2020, there were 218 deaths in prison due to natural causes, which is a staggering increase of 77% compared to a decade prior.
This trend is the consequence of harsher, longer sentences; the rise in the number of convictions for sexual offences (including historical cases); and the absence of timely and transparent processes when it comes to compassionate release when a person in prison has a terminal illness and is approaching death.
Hospice UK argues that the increasing need for better end of life care for imprisoned people is not being met, and given prison population projection, this must be addressed as a matter of urgency. The current lack of good care at the end of life is exacerbated by a general lack of understanding of what end of life care is, combined with entrenched cultures within the prison system.
The report author, Hospice UK Policy and Advocacy Officer, Rini Jones, says: “Despite people in prisons being legally entitled to the same healthcare and treatment as those on the outside, older incarcerated people’s experiences are much worse in comparison to those of the same age in the general population.
“Accounts from inside prisons include people with dementia who didn't know they were in prison being locked in cells alone; frail, elderly people cuffed to hospital beds; and terminally ill people dying in their cells while awaiting the outcomes of application for compassionate release (with the pandemic halting the process for many). These examples, sadly, are all too common.
“We understand that healthcare staff in prisons are not necessarily specialist in palliative and end of life care professionals, but while there is excellent care being provided in some prisons and hospices supporting a small number of English prisons with expert end of life care, it is by no means consistent across the country.
“We at Hospice UK believe that everyone, no matter who they are, where they are or why they are ill, should receive the best possible care at the end of their life. No one should die in avoidable pain or suffering.”
