This month, nursing staff working in WA prisons will simultaneously pick up the phone to improve their knowledge of complex symptom management at the end of life. Last month, 12 of their GP colleagues each made a similarly important phone call, enhancing their skills with insights from a palliative care doctor with 20 years’ experience.

State-wide teleconferences for prison staff are the latest educational initiative to be rolled out by Bethesda Health Care Metropolitan Palliative Care Consultancy Service (MPaCCS) in order to address gaps in palliative care access. MPaCCS also visits prison facilities across the state, providing provide training, reviewing complex cases, providing symptom management advice and answering questions.

MPaCCS clinical nurse consultant, Jan Stiberc, said prison represents a small proportion of the organisation’s work, but improving the quality of palliative care in prisons is fundamental to meeting prisoners’ human rights.

"A lot of prisoners have lived 30 years in the prison and that is their home, so they want to die there with dignity," Ms Stiberc said.

“Doctors and nurses working in prisons are very dedicated and hugely enthusiastic about providing really good palliative care.

“They want to give the prisoners the best care they possibly can under very difficult circumstances, so they are very keen to have as much education as possible.”

The majority of MPaCCS work is at Perth’s residential aged care facilities, where it supported 820 residents last year. The service also visits residential disability services and mental health facilities, where it trains and mentors staff, supports families and helps residents with end-of-life planning.

"A lot of prisoners have lived 30 years in the prison and that is their home, so they want to die there with dignity."

Ms Stiberc said MPaCCS is working to overcome gaps in palliative care access identified by several state government reviews. The reviews have identified prisoners, people who are mentally ill and people who are disabled as groups likely to miss out, and recommend training as an effective way to improve access.

For prison staff, MPaCCS training has focussed on recognising when a prisoner is dying, thinking ahead to predict symptom management needs and knowing when a visit from MPaCCS specialist staff is required.

“We’ve pulled together some criteria to support their decision making because in palliative care things can change very quickly. Someone can be okay one minute and then really deteriorate over the weekend. And if staff don’t have the skills to manage and the patient doesn’t want to go to a tertiary hospital, then at least they have us.”

Ms Stiberc said that as a consultancy, MPaCCS does not take over patient care.

“We can set a plan up and call the staff daily to see how things are going. Knowing they have our medial support behind them, and that they can call us if they need us, means that prison staff feel supported.”

Ms Stiberc said the training and support was having a positive impact. She gave the example of a young prisoner who was dying and “having huge pain issues, emotional issues and shortness of breath”. He didn’t want to go to a tertiary hospital, preferring to stay in the infirmary with people he knew. MPaCCS worked with staff to put a plan in place which enabled him to stay in the prison for several weeks.When his symptoms escalated, MPaCCS referred him to a community hospice, where he died.

Ms Stiberc said MPaCCS is now hoping to explore the possibility of prisoners being able to write advance care directives, and what changes might be required in order for them to be followed within the prison system.