2. Corrections Health Service Complaints Management System in NSW Prisons

3. Presenters Leslie Tak A/Health Planner Maria Hatzidimitris A/Client Liaison & Policy Officer

4. Session Outline Context - Complaints in the NSW Correctional System –Health Services –Demographics –Constraints Complaints Management System –Flow Chart –Statistics –Case Study –Quality Activities –Future Directions

5. Is a statutory corporation that provides a wide range of health services across NSW: –29 correctional centres –10 detention centres and – 6 court/cell police complexes Corrections Health Service

6. Health Services Provided by CHS Mental Health Primary Health Public Health Drug & Alcohol Clinical Services  Oral Health  Physiotherapy  Art Therapy  Occupational Therapy  Radiology

7. Inmate Profile Inmates have a substantially lower socio-economic status than in other communities (Essential Equity) As socio-economic status is a powerful predictor of health status, this fact also has implications for Corrections Health Service

8. Inmate Population  The full time inmate population is projected to increase from 7,300 in 1998/99 to 9,500 in 2008/09  Predominantly young males, with a shift toward older inmates and increase in females inmate numbers.  71% Australian born and 16% born overseas in a non English speaking country  Approximately 16% Aboriginal and Torres Strait Islander

9. Inmate Health Status: General Trends  80% of inmates have been incarcerated for offences related to drug and alcohol use  Some 60% of males and 70% of females have a history of illicit drug use.  Around one third of the males and two third of females are hepatitis C positive  Approximately one third of males and half of females have been assessed or treated for mental illness

10. Constraints Impacting Health Delivery 16,000 annual receptions Length of Stay –27% less than 8 days –17% between 8 and 30 days –56% greater than 30 days Movements –7,500 escorts to court per month –127,000 internal movements per year

11. Constraints cont. Corrections Health Service as separate from Department of Corrective Services Access Security issues supersede health issues Language barriers Cultural barriers Expectations of health services may be unrealistic or non-existent. Public Opinion re Inmates & Health Service

12. Complaints Management Corrections Health Service has a strong commitment to improving the health of people in the NSW correctional system Complaints Management is an integral part of the quality monitoring and improvement cycle

13. Complaints Management - Review 1998 CHS conducted a formal review :  NSW Better Practice Guidelines for Frontline Complaints Handling  NSW Ombudsman’s Effective Complaint Handling Guidelines  Statewide Complaints Data Collection  Better Health Good Health Care

14. Complaints Management System Flow Chart: Path flow for complaint process Statistics: <3% of the inmate population have lodged a complaint 18% of these unsubstantiated Case Study:Symptoms Investigation Outcome Quality Activities Future Directions

15. Source

16. Issues

17. Case Study - Background Complaint to Official Visitor Symptoms: Shortness of Breath Swollen joints & limbs Skin rash Pins & needles Weakness & muscle fatigue Symptoms of arthritis Sharp pains in lower chest

18. Case Study – Investigation Outcomes  Referred to hospital  Missed five appointments  High level security required for external medical appointments  Appointments cancelled due to lack of staffing  Prescribed anti-inflammatory and analgesics  Referred to hospital after symptoms persisted

19. Case Study – Investigation Outcomes  Venous Ultrasound negative & diagnosed with cellulitis  Commenced on antibiotics  Symptoms temporarily reduced  Security measures improved & referred back to hospital  Diagnosed with pleural effusion & anaemia  During admission diagnosed with SLE

20. Key Issues 1.Diagnosis 2.Inadequate Treatment 3.Wrong/Inappropriate Treatment 4.Negligent Treatment

21. Summary of Investigation Outcomes Delays in diagnosis due to environmental constraints DCS and CHS believed to be one organisation Mr X reluctant to seek medical attention after hours

22. Resolution Mechanism Resolution process initiated Mr X satisfied with the treatment provided Enhanced communication Promotion of CHS as a separate entity

23. Quality Activities from Investigation Clinic hours reviewed to address needs of working inmates In-service for CHS staff relating to the impact of security measures Promotion of CHS (via posters, brochures, video)

24. CHS Quality Activities  External Audit of Complaints Management System  Reports to Quality Council, CHS Board, Clinics across the State, NSW DOH  Specialty reports  Complainants’ Satisfaction Survey  Education Sessions  Consultation with Consumers, Consumer and Community Representatives

25.  Inmate Health Survey 2001  Encourage inmates to view complaint as a positive partnership and as constructive measure for improvement  Promotion of the Service as separate to the Department of Corrective Services  Multilingual Patient Information Brochure  Posters for inmates on how to lodge a complaint CHS Future Directions