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
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