Improving Access to Health Services for Women in Custody

Justice Health Service

Abstract

Escort issues and security concerns resulted in appointment cancellations and delayed access to health services for women in custody. After much negotiation between Sydney West Area Health Service, Department of Corrective Services (DCS) and Justice Health the Westmead Transit Lounge was purpose built to provide a secure waiting area for females in custody attending outpatient appointments.

With the cooperation of senior personnel within each agency a coordinated approach to facilitating medical appointments and health care was implemented.

Data collection processes were initiated to review the ongoing effectiveness of the Lounge and access to health services. The number of medical appointments facilitated in the period from November to January 2008 is 168 compared to 109 from August to October 2007.

Aim

To increase the number of external medical appointments facilitated to improve access to healthcare and to accommodate patients in a secure environment reducing the risk of escape and anxiety to the public.  

Nature of the Problem

Issues were identified regarding increasing numbers of medical appointment cancellations within the female custodial environment. This also resulted in patient complaints and untimely delays in diagnosis resulting in poor clinical outcomes. Several operational models were considered by Justice Health and DCS to address these issues. The concept of a secure lounge area was conceived and discussions with SWAHS commenced with an area at Westmead Hospital identified where the lounge could be built. The Transit Lounge would allow for patients to be accommodated in a secure area whilst medical appointments were facilitated.

Extent of the Problem

From July to December 2006, 597 medical appointments were facilitated for women from four female correctional centres with appointments accessed across more than eight hospitals creating problems for DCS transport and escorting officers. 542 medical appointments were cancelled during this period; reasons for cancellations were varied but included the patient being transferred from one centre to another, DCS not being able to provide the escort due to existing booked appointments or a more urgent appointment and DCS officer shortage.

Extensive consultation between DCS, SWAHS and Justice Health resulted in the Westmead Transit Lounge opening in November 2007 and a trial commencing two days per week to review processes and the effectiveness of the Lounge. Prior to the opening of the Transit Lounge 33 external appointments were facilitated on Mondays and Tuesdays compared to 108 over 3 months after opening.

Strategic Importance

Improving access to health services for women in custody through the Westmead Transit Lounge aligns with the NSW Health strategic direction Create Better Experiences for People Using Health Services and is also consistent with the Justice Health Clinical & Nursing Services Business Plan strategy   identifying the development of a process to better manage clinical risk whilst improving access to health care.

In the past optimal clinical outcomes have not always been achieved. A patient had 12 external appointments booked between April 2005 and November 2006 for lesion review with only 6 appointments facilitated. The patient was eventually diagnosed with melanoma.

Planning and Implementing Solutions

The Westmead Transit Lounge was completed and handed over to DCS in September 2006. In December 2006 negotiations commenced between DCS and Justice Health, with business cases tabled demonstrating how significant benefits could be realised by both organisations. These included:

• An increase in the number of medical appointments that could be facilitated.
• A decrease in overall escort costs for DCS by redeploying staff to a central unit.
• The provision of a safe, secure and private area for patients to wait before and after appointments.
• A decrease in medical appointment cancellations.

An agreement was reached to conduct a trial of the Lounge utilising two days of the week to facilitate medical appointments. As part of the discussions it was identified that Mondays and Tuesdays were the best days for the patients to access the largest range of medical appointments at Westmead Hospital.

The trial commenced in November 2007 and the following occurred to ensure operational effectiveness of the unit:

• Extensive consultation with the project manager for DCS and key nursing staff and managers at Westmead Hospital. Communication with Westmead staff included information about our client group, roles of accompanying officers and the purpose of the Lounge.
• The development of an Operational Plan which included topics such as security, escorts, evacuation processes and facility management.
• Identification of escort routes within the hospital.
• Establishment of a database for utilisation in the evaluation phase.
• Orientation of DCS staff to the unit and the establishment of a DCS supervisory post.
• Communication channels established with the General Managers of the correctional centres, Medical Appointments Unit, DCS project manager, Nursing Unit Managers and JH Service Director Women’s Health.
• Regular meetings scheduled to review issues and progress.

Outcomes and Evaluation

Data analysis demonstrates an increase in medical appointment facilitation and a decrease in cancellations. The trial was completed in February 2008 and the following statistical information was collected:

1. Number of medical appointments facilitated from women’s centres (excluding Berrima) Monday to Friday from August to October 2007 compared with November to January 2008, when the Westmead Transit Lounge was operational (Table 1 and Graph 1).
2. Number of medical appointments facilitated from the women’s centres (excluding Berrima) on Mondays and Tuesdays from August to October 2007 compared with November to January 2008 when the Westmead Transit Lounge was operational (Table 2 and Graph 2).
3. Number of medical appointments cancelled and reasons on Mondays and Tuesdays during the operation of the Westmead Transit Lounge (Table 3 and Graph 3).

NB. The pre Transit Lounge figure includes medical appointments booked at any facility.

Table 1.

Graph 1.

Table 2.

Graph 2.

 
Table 3.

Graph 3.

The outcomes of the trial and initial data collection and analysis provides evidence to support the progression of the Westmead Transit Lounge initiative to a five day per week operation, to allow further demonstration of positive outcomes in terms of accessing health services for our disadvantaged clientele.

Sustaining Change

The Westmead Transit Lounge project is a key focus area for the Justice Health Board and is a regular agenda item for their meetings.

The Nursing Unit Managers are responsible for reviewing medical appointments at their sites and identifying potential issues and liaising with local DCS officers to try and ensure appointments are facilitated.

The JH Service Director Women’s Health, continually monitors the operation of the Lounge and reviews data.

The Lounge is a regular topic discussed at DCS/Justice Health meetings. 

Future Scope

Justice Health is currently liaising with DCS in relation to progressing the Transit Lounge to a five day per week operation with a view to including the adult male custodial population who currently attend Prince of Wales Hospital for medical appointments. The utilisation of the Transit Lounge for male medical appointments would also allow for increased appointment bookings.
DCS would benefit by being able to decrease the number of escorts out of the western metropolitan area resulting in efficiencies in officer deployment.

The Transit Lounge has been able to demonstrate positive outcomes for patients in terms of accessing health services.

Contact

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