The waiting room was empty except for G and I. He came in and sat down quietly, and never took his eyes off his shoes. A young man, perhaps 35 or so, of African descent I would imagine, with his coal black skin. Visitors to that waiting room rarely speak to each other; we are all lost in our own thoughts, battling our own demons. We don’t need to inquire; there is only one reason why you are waiting to be seen by the palliative care ‘pain clinic’.

Whereas I could feel the warmth of Mr G’s arm pressed up next to mine in silent support – he only had the cold comfort of the metal shackle binding him to the arm of his companion. The other side of him sat another uniformed officer. They both stared straight ahead. You can’t blame them; prison officers aren’t hired for their empathy and hand holding qualities, they have other functions in their job.

‘Strewth’, I thought, ‘Ain’t that the truth’? – ‘Just when you are in danger of feeling sorry for yourself, life manages to remind you that things could be worse’.

When I got home I started Googling. We have an ever growing elderly prison population; I had looked into the issue of specially adapted cells for wheelchairs with bed hoists and bath lifts – but what happens when they develope terminal illnesses, cancer; or that horror child of impending doom – muscular dystrophy – as the law of averages says some will?

The number of older prisoners in the UK has more than doubled in the last decade, with the greatest increases amongst those over 70. Around 40% of older prisoners are sex offenders, many of whom are in prison for the first time due to historic abuse. Longer sentences and more stringent release criteria mean that increasing numbers of ‘anticipated deaths’ in prison are predicted.

I had fondly imagined that the few prisoners who grew old enough to develope terminal illness were released on compassionate grounds; a belief probably encouraged by the publicity surrounding Ronnie Biggs’ release to allow him to die at home surrounded by his family. That is a rarity, rather than the norm – and not truly the result of an uncaring prison system comprised of vitriolic psychopathic prison staff!

Back in 2007, it was proposed that the discharge grant be raised to £114.90; the amount has remained stubbornly at £46.75. Not a penny more, not a penny less. A high proportion of long term prisoners and elderly prisoners no longer have a family network to return to. They are officially ‘No Fixed Abode’. Sleeping rough or moving hostels every few days is not a lot of fun for anybody – it is out of the question for those living through the last few days of terminal illness. Staying in prison is actually a prefered option.

Utilising existing hospices for serving prisoners? The media would just love that! Heart rending tales of when Granny met the ‘Sheffield Strangler’ as she lay dying and spent her last moments in abject terror, would write themselves. Nobody would bother to point out that the ‘Sheffield Strangler’ was semi-conscious, immobile, delirious, and in no fit state to harm anyone…

The only remaining option is to turn sections of the prison estate into mini-hospices. That is, in small pockets, what has in fact happened – with varying degrees of success. There be dragons there too.

They may be called hospice units – but they are still prison. At night, it is still a cell.

The cells are small, averaging six by eight feet, and built for single occupancy. Privacy goes out the window very quickly. The cell toilet is located usually right beside the door. It’s not sectioned off. You eat your dinner just a couple of feet away from an open toilet.

You will be locked in at night, that’s how prisons operate. If you throw up for an hour at 4am, there’s no kindly companion to mop your brow and make you a cup of tea, in fact there’s no companion at all. If you are in terrible agony, there’s no Macmillan nurse to moisten your lips and up your medication – you are on your own. As was Ronald Sherlock – found dead the next morning at 11.30am – ironically in Norwich Prison, probably the best prison for palliative care.

Sherlock, who was jailed in 1979, was transferred to Norwich Prison in 2005 and was seriously ill with heart problems, prostate cancer, diabetes, chronic kidney disease, lung cancer and had developed Alzheimer’s Disease, the inquest heard.

In the majority of prisons, a Macmillan nurse attends on a Wednesday. Which is a long time to wait if you have taken a turn for the decidedly worse on the previous Saturday. If she is able to up your pain relief, if you are lucky, the prison authorities will be able to collect it in time for the following Saturday. That is assuming she is able to up your medication. There is a major issue in prisons surrounding the euphemistically named ‘pain relief’.

The next step up from Morphine is a Fentanyl patch giving 24 hour relief. Sadly Fentanyl patches are a heroin derivative.

Both used and unused fentanyl patches have been injected, smoked, snorted or taken orally with fatal consequences.

Nobody is suggesting that the terminally ill are going to willingly exchange their Fentanyl patch for half a dozen Mars bars (or if they are, then they have never been in excruciating agony as cancer eats through their bones). However, they can be peeled off semi-conscious inmates, easily secreted, and then misused throughout the general prison.

Prison Governors don’t want Fentanyl floating round their prison; they have the same reservations about ‘pump drivers’ delivering other options – the needles can be removed – so the options for pain relief are limited, take an inordinate time to travel through the prison system, and definitely are not available at the hands of a kindly nurse in the middle of the night.

I don’t care how much of a rough, tough, bank robber you are, or a teenage arsonist still awaiting a suitable course to get you off your indeterminate prison sentence – cancer treatments are terrifying. They turn the strongest person into a wobbling, wailing, chunk of blubber who only wants everyone in the vicinity to be extremely nice to them…

Dying alone in a small cell in screaming agony is no part of the punishment that I have ever heard a judge hand down. I would say it probably engages Article 3, and would hope that some Human Rights lawyer reads this and takes up the cudgel on behalf of the several hundred prisoners currently in this situation.

I can’t say it is the fault of the prison authorities – they have to run their prisons to serve several different masters which are incompatible with the needs of the terminally ill.

A large number of those elderly prisoners are sex offenders. There will be those who take a visceral pleasure at the thought of them dying in such a manner – serves them right, they will say; deserve everything they get. This will also be the reaction of the media, should the Justice department attempt to rectify the situation other than by stealth. They will pick the most heinous and celebrated offender and invite their readers to ‘vote’ on whether they deserve any better a death than that portrayed.

Equally, a fair sized proportion of those affected aren’t sex offenders.

Stephen Downing narrowly escaped dying in jail. Protesting his innocence saw him labelled ‘in denial’ and thus ineligible to be released from his life sentence. He is now hailed as ‘the longest miscarriage of justice in history’ after his 27 years in prison. He is the darling of the liberal left – would they be happy had he died a miserable, frightening, painful death in the mean time? He was an innocent man.

Danny was an 18 year old imprisoned on an indeterminate sentence for two bungled burglaries, now the same age as the young man I sat opposite in the clinic. Did you want to tell me that he deserves to die in medieval conditions, should he contract a terminal illness?

What is needed is for one prison to be a dedicated unit for the elderly, with hospice facilities attached – and no other function. Albany jail in the Isle of Wight has made a spirited attempt, developing a dedicated unit with an enclosed garden in the centre of the jail; it includes a small unit overlooking the garden where those who wish can spend their final days. However, so long as there are other prisoners housed on the same estate, as at Albany, it doesn’t solve all the problems regarding pain medication, nor, quite understandably, does it deal with the issue of prison officers not being hired for their lip moistening and hand holding qualities.

Norwich Prison, the forerunner in trying to do ‘this’ better, has just announced that ‘L’ wing will shortly be a smoke free environment. No doubt, when there has been little complaint from the semi-comatose inhabitants of that wing, it will be decreed a success and rolled out through the entire prison. Bet they don’t spell out the function of ‘L’wing to the media. Need I tell you which is ‘L’ wing? Yep, the terminally ill will be the first to be denied a last gasp of nicotine…

With the growing elderly population, I wonder whether Amber Rudd has the backbone to ignore the media manipulation that will occur, should she deign to attack this problem head on.

I’d cheer her to the rafters if she did. Prisoners, whatever their crime, are still human beings. Any Human Rights lawyers listening?

Discuss.

Addendum: I’m adding two very helpful articles on the subject that you may find useful if you want to follow up on this subject. There is surprisingly little information available.

Part One.

Part Two.