Access unlocked: Improving patient access to care in NSW correctional settings

People in custody are among the most disadvantaged members in the community, whose health needs are often more complex than the general population.¹ Unlike other care settings, health staff are limited by corrections-led facility routines and rely on custodial officers to facilitate patient escorts to the onsite health centre.

While prisoner rights to community equivalent healthcare are enshrined in the United Nation’s Mandela Rules,² access to care in custody in NSW varies across each facility and is Justice Health NSW’s highest rated organisational risk. Key examples include two patient deaths in 2021-22 where access issues were a contributing factor and continuing high rates of access-related appointment cancellations impacting service efficiency and effectiveness. The impact of poor access is reflected in patient feedback, with less than one in five (19.5%) rating the health care they receive in prison as good.³

This project aims to reduce variations in patient access to care in NSW public adult correctional centres by June 2024, so that patients can receive the right care at the right time. Patient access to care in custody varies across each facility because there are differences in security classification, patient flow, poor communication between teams and variations in how clinics are coordinated.⁴ We are changing the way we coordinate and collaborate on care to make access easier, maximise clinical resources and enhance the service experience of patients and staff.

The project team adopted an evidence-informed and collaborative approach led by patients and staff to confirm key issues and define how we address access barriers that impact patient outcomes and service quality and efficiency. Patients, health and custodial staff told us we should improve care access by leveraging digital solutions, standardising processes and working with Corrective Services NSW (CSNSW) to improve access to patients. Solution workshops and prioritisation led to five solutions:

• create direct patient self-referral options and a digital patient portal
• establish a joint access-related key performance indicator with CSNSW
• clinic coordinator role in each correctional facility health centre
• deploy a digital clinic booking system and centralised scheduling team
• expand virtual care options.

Implementation is underway against all solutions, with key actions and milestones scheduled to occur across three phases over 16 months. A pilot patient self-referral phone line (part of solution one) completed in phase one, showed progressive uptake of this format and a slight decrease in the existing paper-based process. This was consistent with patient feedback in diagnostics that patients wanted choices in how to seek health care in custody. 90% of surveyed patients said that the phone-based self-referral experience was better than the paper-based process.

View this project's poster from the Centre for Healthcare Redesign graduation August 2023.

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