prison health care the real quality story gp 15/1... · our prison population • approximately 50%...

RNZCGP CONFERENCE, HAMILTON 1 AUGUST 2015

PRISON HEALTH CARE

– THE REAL QUALITY STORY

Kirsty Fraser & Fiona Irving

Clinical Quality Assurance Advisors

Health Services, Department of Corrections

Northland Region

Correctional Facility

• Auckland Prison

• Auckland Women’s

Otago Correctional Facility

Invercargill Prison

•Christchurch Prison

•Christchurch Women’s Prison

•Rolleston Prison

•Rimutaka Prison

•Arohata Prison

•Whanganui Prison

•Manawatu Prison

Tongariro-Rangipo Prison

Hawkes Bay Prison

•Springhill Correctional Facility

•Waikeria Prison

Location of

prisons in

New Zealand

SPRING HILL - WAIKATO

HISTORICALLY….

• 1840’s Medical Officer appointments to NZ prisons

• 1881 Hume Report – more prescriptive responsibilities

of the medical officer

• 1918 Nurses started working part-time in borstals

• 1922 Tokanui Hospital superintendent also the

superintendent of Waikeria Prison

• 1976 Custodial staff administered penicillin to the

wrong prisoner who died of anaphylaxis

THE TURN OF THE 21ST CENTURY….

Greater focus on the health needs of prisoners

Policy Development

Quality Assurance

Clinical team to provide advice

CORRECTIONS ACT 2004

The standard of health care that is

available to prisoners in a prison

must be reasonably equivalent

to the standard of health care

available to the public

STRUCTURE

National Office - Director of Offender Health

- Principal Health Advisor

- Business Support Team

Regional (x4) - Regional Clinical Director

- Clinical Quality Assurance Advisor

Prison (x16) - Health Centre Manager (may be

responsible for more than one site)

- Some sites have Team Leaders

- Nurses

- Some sites have HCA’s

- Administration support

OUR PRISON POPULATION

• Approximately 50% Maori, 5% Women

• Generally arrive in poorer health than

general population

• Mental Health (MHST)

• AOD (ASIST tool)

• Chronic conditions / hearing impairment /

TBI

• Our prison population is also ageing

(coming in older as well)

MOVING WITH THE TIMES…

EXTERNAL CONTRACTORS

• Medical Officers

• Dentists (on-site facilities & external)

• Pharmacist

• Physiotherapist

WHAT DO WE FOCUS ON?

• Chronic disease management

• Staff development (PHEC, PMH, & AOD)

• Professional Development and

Recognition Programme (CDHB)

• Working closely with our custodial

colleagues

• Strong emphasis on health screening

• Health promotion (including families)

CONTINUED….

• Engaging with the wider health sector

• Clinical Governance structure (MoH)

• Infection control surveillance

• Service Level agreements with DHBs

and Forensic Services

• Internal auditing

• Looking at our future model of care

EXPANDED PRIMARY CARE SERVICE

• Nurse-led clinics

• Medication administration & self administration

• ‘Normal’ emergency management issues

• Management of new prisoners who are

detoxing

• Hunger strikes

• Assaults and self harm

• Acute mental health issues

• Internal concealment

CHALLENGES…..

MORE CHALLENGES….

• Escorting custodial officers to get our patients

to the health centre / hospital

• Classification of prisoners impacts on the way

we deliver health services

• Hospitals discharging patients to their ‘home’

• A primary care health service with ‘on-call’

staff overnight

CHALLENGES CONTINUED….

• Prisoners transferring to other prisons with

on-going health needs

• Prisoners being released with no GP

• Difficulty getting some practices to take on

new patients

• Environment where medication (and other

items such as NRT) can be diverted and

traded

QUALITY ACHIEVEMENTS OVER THE

LAST 10 YEARS An example of some national

policy development Quality initiatives

• Initial Health Assessment

• Health Care Pathway

• Health Promotion

• Opioid Substitution

• Clinical Emergencies

• Infection Control

• Voluntary Refusal of Food

• End of Life

• Clinical Governance

Framework

• Health Screening

• PDRP

• Cornerstone

• Harm minimisation

• Clinical High Risk Register

• HDU

• NETP

• Core training

• Numbers not as significant as you may think

• 5% of prisoner muster

• Screening programme in conjunction with

Hepatitis Foundation

HEPATITIS C

TATTOOING DEVICE

HIGH DEPENDENCY UNIT

• The only unit in the country run by health services

• Different philosophical stance (eg. mixed

classifications)

• 30 (hospital) beds

• RN cover 0800-1700hrs, 7 days a week (on call)

• 24/7 HCA support

• Assistance with ADL’s

• Own treatment room / drug room

• Disability showering facilities

• Constructive activities

• Van with wheelchair capability

HIGH DEPENDENCY UNIT

TREATMENT ROOM

• Why? To benchmark what can be achieved in a correctional institution

• How? Employed a contractor for initial guidance / advice

• Goal – 3 years for 16 prisons

DID WE ACHIEVE OUR GOAL?

• Already aiming for nationally consistent practice

• National policies / business plan / resources

• Started with the four sites most likely to succeed

• Yes, there was a lot of work to do, but probably less than the average PHO

• Same two RNZCGP assessors for all prisons

SEQUENCE OF HEALTH SERVICES

WITHIN PRISONS ACHIEVING

ACCREDITATION

• 2011 Whanganui, Auckland Women’s, Tongariro-Rangipo, Otago

• 2012 Christchurch Women’s, Spring Hill, Christchurch

• 2013 Waikeria, Rolleston, Rimutaka, Hawkes Bay, Invercargill

• 2014 Arohata, Manawatu, Auckland, Northland

KEYS TO SUCCESS

– ONE PRISON’S STORY

- Staff of 21 nurses, 2 team leaders, 3

administration support staff

- Nurses haven’t necessarily come into

Corrections with a primary care

background

- ‘Cornerstone’ foreign to them – what does

it mean? How does it affect me? Why

bother?

- Communication

- Get smart with your language

- Getting everyone on-board

- Set goals

- Keep the momentum going

- Celebrate

WE THINK …..

• We are the only prison health service world-wide

that is nationally accredited against an external

community standard

• First country to introduce national smoking

cessation

We also think that we are the only country with :

• National electronic clinical record system

• National Incident Reporting system

• National Clinical Governance Framework

ONGOING JOURNEY…..

• Funded by Vote Corrections – reducing re-

offending by 25% by 2017

• Align ourselves with the wider health sector

within the constraints of being situated in a

prison

• Our prisoners are part of your DHB

• More facilities for the frail / elderly

• Health Services aims to provide clinically

excellent, patient-centred care for prisoners