Offender health services review

In 2012 with the implementation of the national hospital and health reforms, public offender health services in Queensland were devolved to relevant Hospital and Health Services (HHSs). While the delivery of offender health services was devolved, there was no coordinated central governance arrangement established to address state-wide or systemic issues.

The prison population is one of the most stigmatised and socially disadvantaged groups in Australia. Generally prisoners have lower levels of education, are social isolated, financially dependent and experience high levels of poor physical health, psychiatric illness and engage in risky behaviours such as tobacco use, violence, increased alcohol consumption and illicit drug use when compared with the general population.

Improving the health of prisoners is a hallmark of a just society. It is also an important public health measure given that the prisoner population moves between prisons and the wider community.

Queensland has international obligations to ensure that prisoners enjoy the same standards of health care is available in the wider community, and have access to necessary health-care services free of charge without discrimination on the grounds of their legal status.

The project will be conducted in two phases.

Phase 1 - Conduct a review of offender health services and to develop a plan to improve the governance arrangements for publicly provided offender health services. The review will be wide ranging and include matters such as: the nature of services, models of care, workforce issues, workforce safety, quality of care, service demand and funding issues.

Phase 2 - Implement the approved plan.

Phase 1 of the project has now been completed and the Report from the independent Offender Health Services Review is now available.

Key findings from the Review include:

• The vast majority of health staff strive to provide quality health services for prisoners. Each day these staff provide health care and treatment to a group of people that are not well understood and are in some cases shunned by the broader community. Prisoners generally have more complex health needs with a high prevalence of mental health conditions, communicable diseases illicit drug use, poor oral health, and chronic diseases when compared to the general population. Compounding this, is that this group is generally socially and economically disadvantaged prior to entering prison and will tend to be more so upon release into the community making them more reliant on social support systems.
• The efforts of health staff have however been hampered by a lack of leadership which has meant that many system-wide challenges such as overcrowding, insufficient clinic space and differences in operational requirements between Queensland Corrective Services and the Department of Health are not being adequately addressed. The consequence of this has been:
  • A workforce that at times feel unsupported and frustrated by their inability to deliver the level and standard of services that they strive to provide.
  • A prison population whose health care needs have not been well met.
  • A loss of focus on quality and patient-centred care.
  • Inefficiencies in the delivery of care due to the need to focus on day to day care delivery with no capacity to address issues strategically.
  • Fragmentation in the delivery of services.
  • Significant variability in the nature and availability of services.
• The review Report contains a range of recommendations across the following five broad themes:
  1. Relationships and Governance
  2. Workforce
  3. Access
  4. Service Standards and Models
  5. The Correctional Environment and Interfaces with QCS
• The Department of Health has carefully examined the report and has decided to accept or support all the recommendations and has commenced working on key priorities.
• A key priority is the establishment of an Office for Prisoner Health and Wellbeing in Clinical Excellence Queensland, a division of the Department of Health. This Office will assume responsibility for the implementation of the recommendations including the establishment of effective collaborative arrangements with Hospital and Health Services, Queensland Corrective Services and other key stakeholders to address the system-wide challenges.
• Whilst the Office for Prisoner Health and Wellbeing will assume systemwide leadership responsibility, relevant Hospital and Health Services will remain responsible for the delivery of health care for people in prison.

Key to the success of this project was broad and deep consultation with people and organisations who play a key role in the provision of offender health services.Phase 1 and the initial stages of phase 2_ was guided by the Offender Health Services Steering Committee Alliance (OHSSCA, pronounced “Oscar”) which was chaired by the Dr John Wakefield, Deputy Director-General, Clinical Excellence Queensland, a division of the Department of Health. Membership of the steering committee was cross-sectorial and included representatives from:

• Hospital and Health Services
• Queensland Corrective Services
• Office of the Health Ombudsman
• Health Consumers Queensland
• The Queensland Nurses and Midwives’ Union

For a status update on the Offender Health Services Review, please see the Publications section below

• Offender Health Services Review Report
• Offender Health Services—Fact sheet (January 2018)
• Offender Health Services—A consumer perspective

Project updates

• Offender Health Services Governance Improvement Project – Update 1 (November 2019)

Project communiqués

• Offender Health Services Governance Improvement Project – Communique 5 (February 2019)
• Offender Health Services Governance Improvement Project – Communique 4 (July 2018)
• Offender Health Services Governance Improvement Project – Communique 3 (June 2018)
• Offender Health Services Governance Improvement Project – Communique 2 (March 2018)
• Offender Health Services Governance Improvement Project – Communique 1 (January 2018)