Prison health services model unsustainable
Office of the Ombudsmen
Te Tari-o-Ngā Kaitiaki Mana Tangata
Prison health services model unsustainable, says Ombudsmen’s Office
Taxpayers would get better value and prisoners a better level of healthcare if prison health services were delivered by a health agency rather than the Department of Corrections.
That’s according to a report by the Office of the Ombudsmen tabled in Parliament today.
The report by Chief Ombudsman Beverley Wakem and Ombudsman David McGee is the result of an investigation into the provision, access and availability of prison health services.
Beverley Wakem says the investigation found that prisoners have reasonable access to health services and generally receive healthcare equivalent to the wider community, as is required under legislation.
However, the Office was of the view that prison healthcare was reactive rather than proactive, with a lack of direction and poor lines of communication.
“There needs to be a greater emphasis on health needs, rather than custodial and management issues determining the quality of healthcare a prisoner receives.”
The department’s health services budget is not ring-fenced and should the Department be forced to reduce spending, this could impact on the ability of health services to provide a full range of services. In one case, health services were forced to cancel nurse training on the methadone policy because there were insufficient funds available to do so.
“Unless the health budget is protected, the failure to adequately treat unwell prisoners while they are imprisoned will ultimately place demand on District Health Board Services when they are released back into their communities,” the report says.
Custodial staff shortages can also impact on efficient operation of health services. At one prison, only one custodial staff member was available to escort prisoners to health clinics, meaning prison nurses and the visiting doctor had to sit and wait while each prisoner was returned the unit and the next prisoner was escorted to the Health Centre.
The fact that prison health services were not provided by a Primary Health Organisation meant that prisoners were ineligible for PHO-funded programmes that they could benefit from, and that could reduce a long-term burden on the public health system upon their release.
The Department of Corrections also paid more for prescriptions because its health services were not provided by a PHO – sometimes up to $15 per prescription, rather than $3 – and concerns were raised by health service staff about the high proportion of medicine wastage in prisons.
The report raised concerns that the expected pressure of increased prisoner numbers and difficulties in recruitment and retention of nurses, and in some cases medical officers and dentists, would undermine the ability of prison health services to meet the health needs of prisoners.
“The existing department-delivered model may not, in the long term, be financially and organisationally sustainable,” the report says.
Beverley Wakem says it is also of concern that no external health agency has ever assessed standards of care provided by prison health services against recognised standards of healthcare. A regular audit by an external health agency should occur on an ongoing basis.
The report found better collaboration was needed between the Department of Corrections and various health agencies. However, the Office was pleased to see during the period of the investigation, the Department acting on some of the areas of concern that the Ombudsmen raised.
Beverley Wakem says the Ombudsmen’s Office is now considering carrying out a specific own-motion investigation into mental health in prisons.
“There is a disproportionately large number of prisoners with mental health issues, and they place an enormous burden on the Department of Corrections staff, not just health services staff, but also custodial staff.
“We regard the current situation whereby custodial staff have to manage prisoners who, by any lay person’s measure, are grossly disturbed is unsatisfactory for both prisoners and staff.”
The investigation found mental healthcare in prisons was variable, and in general insufficiently responsive to the diverse needs of prisoners with mental health problems.