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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
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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
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SPRING HILL - WAIKATO
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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
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THE TURN OF THE 21ST CENTURY….
Greater focus on the health needs of prisoners
Policy Development
Quality Assurance
Clinical team to provide advice
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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
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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
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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)
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MOVING WITH THE TIMES…
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EXTERNAL CONTRACTORS
• Medical Officers
• Dentists (on-site facilities & external)
• Pharmacist
• Physiotherapist
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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)
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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
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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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CHALLENGES…..
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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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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
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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
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• Numbers not as significant as you may think
• 5% of prisoner muster
• Screening programme in conjunction with
Hepatitis Foundation
HEPATITIS C
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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
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HIGH DEPENDENCY UNIT
TREATMENT ROOM
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• 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
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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
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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
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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?
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- Communication
- Get smart with your language
- Getting everyone on-board
- Set goals
- Keep the momentum going
- Celebrate
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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
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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
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