PRISON HEALTH CARE THE REAL QUALITY STORY

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1 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

2 Location of prisons in New Zealand Northland Region Correctional Facility Auckland Prison Auckland Women s Tongariro-Rangipo Prison Whanganui Prison Manawatu Prison Otago Correctional Facility Invercargill Prison Springhill Correctional Facility Waikeria Prison Hawkes Bay Prison Rimutaka Prison Arohata Prison Christchurch Prison Christchurch Women s Prison Rolleston Prison

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4 SPRING HILL - WAIKATO

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6 HISTORICALLY 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

7 THE TURN OF THE 21ST CENTURY. Greater focus on the health needs of prisoners Policy Development Quality Assurance Clinical team to provide advice

8 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

9 STRUCTURE National Office - Director of Offender Health Regional (x4) Prison (x16) - Principal Health Advisor - Business Support Team - Regional Clinical Director - Clinical Quality Assurance Advisor - Health Centre Manager (may be responsible for more than one site) - Some sites have Team Leaders - Nurses - Some sites have HCA s - Administration support

10 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)

11 MOVING WITH THE TIMES

12 EXTERNAL CONTRACTORS Medical Officers Dentists (on-site facilities & external) Pharmacist Physiotherapist

13 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)

14 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

15 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

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17 CHALLENGES..

18 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

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20 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

21 QUALITY ACHIEVEMENTS OVER THE LAST 10 YEARS An example of some national policy development Initial Health Assessment Health Care Pathway Health Promotion Opioid Substitution Clinical Emergencies Infection Control Voluntary Refusal of Food End of Life Quality initiatives Clinical Governance Framework Health Screening PDRP Cornerstone Harm minimisation Clinical High Risk Register HDU NETP Core training

22 HEPATITIS C Numbers not as significant as you may think 5% of prisoner muster Screening programme in conjunction with Hepatitis Foundation

23 TATTOOING DEVICE

24 HIGH DEPENDENCY UNIT The only unit in the country run by health services Different philosophical stance (eg. mixed classifications) 30 (hospital) beds RN cover hrs, 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

25 HIGH DEPENDENCY UNIT TREATMENT ROOM

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29 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

30 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

31 SEQUENCE OF HEALTH SERVICES WITHIN PRISONS ACHIEVING ACCREDITATION Whanganui, Auckland Women s, Tongariro-Rangipo, Otago Christchurch Women s, Spring Hill, Christchurch Waikeria, Rolleston, Rimutaka, Hawkes Bay, Invercargill Arohata, Manawatu, Auckland, Northland

32 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?

33 - Communication - Get smart with your language - Getting everyone on-board - Set goals - Keep the momentum going - Celebrate

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35 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

36 ONGOING JOURNEY.. Funded by Vote Corrections reducing reoffending 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

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