The soon-to-open Clarence Correctional Centre near Grafton is slated to be ready to accept prisoners by July 2020, however the preparedness of the system to accommodate inmates needs to be matched by the provision of essential community resources such as housing, and a proper assessment of the impact on local (and regional) health services beyond the prison walls.
As has been discovered elsewhere, this is a very complex social and public health issue. When it comes to health if there is one stand out issue of concern it is the interface between NSW Health, the funder of hospitals and justice and community health, and the federally funded Medicare system.
Adding to the complexity is that in NSW there are both State and privately run prisons. However the NSW Justice Health and Forensic Mental Health Network that manage prisoner health also have a monitoring role within private jails, including medical records being handled by their software and stored on their data base.
When it comes to clinical handover of care for prisoners after their release, ideally the system should be similar to a patient being discharged from a NSW public hospital. The NCPHN is working with the NNSWLHD and has put a lot of effort into improving this clinical handover of care to GPs, with great success.
Unfortunately this is not the case with clinical records collected in jails. There are barriers and delays with these being handed over to GPs and mostly a proper transfer of clinical care does not happen at all.
This results in unnecessary duplication of pathology and radiological testing, which is a burden on the cost to the health system, and frustrating to both clinician and patient. It can also be risky, with a GP being unable to continue the care with confidence without timely access to important clinical information.
Could the use of the My Health Record (MHR) help? Under the current system the answer is ‘no’. This is because the doctors working in jails are unable to access these MHRs records as prisoners don’t have Medicare access.
Australia lags other developed countries in justice health and there are plenty of models overseas where the health of prisoners is better managed. Scandinavian countries stand out in their approach to this issue.
The NCPHN Clinical Council is approaching these issues in three ways.
1) Improving the clinical handover of patient care between NSW jails (whether Government or privately run) and GP primary care services following release from custody.
2) Looking at ways of diverting offenders who have significant mental health problems or cognitive impairment away from incarceration towards rehabilitative treatment programs.
3) Exploring better follow up of GP services to residents using telehealth consultations to this remote site.
All these measures will need funding but potentially there would be significant cost savings to Corrective Services NSW and the health system, State and Federal.
There is goodwill within the NSW Justice Health and Forensic Mental Health Network to work with the NCPHN Clinical Council to improve the situation regarding clinical handover.
However, at some stage there needs to be goodwill coming from the Federal Government in addressing the use of the MHR in jails to improve communication of medical records between health providers. This is a political matter but now is the time for this to be addressed.
A proper system would be for the betterment of prisoners’ health and, in all likelihood, contribute to reducing recidivism. In turn this would lead to dual cost savings for both corrective and health services.
