Embed Size (px)
Citation preview
Correctional Health Services Transition to the Provincial Health Services Authority
Lynn Pelletier - Vice President, PHSAAndrew MacFarlane, Provincial Executive DirectorNader Sharifi, Medical Director
October 25, 2018
2 Transition of CHS to PHSA
Presentation Outline1. Overview & Background 2. Transition Process3. Key Achievements4. Challenges & Opportunities5. Summary6. Q & A
3 Transition of CHS to PHSA
Overview of BCMHSUS• BCMHSUS provides a range of specialized health services
for people with mental health and substance use issues across BC
• Examples of our services include:– Provincial, specialized inpatient and outpatient MHSU services– Forensic psychiatric services for people involved with the criminal justice
system
• Effective October 1, 2017, BCMHSUS assumed responsibility for health care services provided in the ten provincial correctional centres in British Columbia
4 Transition of CHS to PHSA
History of Correctional Health in BC
Pre-2003: Delivered through a combination of BC Corrections staff and separate service contracts
April 2003: Correctional health contracts consolidated into one provincial contract, single provider
April 2014: Deputy Solicitor General and the Deputy Minister of Health directed ministries to undertake a review of correctional health services
5 Transition of CHS to PHSA
Review Findings (2014)• Primary health care is episodic• Unmet mental health and addiction
needs• Poor continuity of care• Practices not always meeting current
standards• Infection control practices require
improvement• Gaps in management of
pharmaceutical services• No process for reporting medication
errors
6 Transition of CHS to PHSA
The Case for ChangeHistory of problems with the delivery of correctional health services in BC • Rapid turnover of providers (4 contractors in 12 years) and little
integration with RHAs and community
Reviews/audits/reports calling for change:• World Health Organization Report on Prison Health(2013)• BC Coroner’s Report (2014) • BC Auditor General Report (2015)
Transition of correctional health services to the health sector in several other jurisdictions (e.g., Alberta, Nova Scotia)
7 Transition of CHS to PHSA
Preparing for the Transition
July 2015 -Project Charter
signed
April 2016 -PHSA conducts a review and develops a
service delivery model/business
case
May 2016 -MOU signed by
Ministry of Public Safety &
Solicitor General & Ministry of
Health
December 2016 - Ministries
submit a request to
Treasury Board for funding to implement the PHSA service
delivery model
January 2017 -TB funding approval
February 2017 -PHSA Board
approval
October 1, 2017 - Assumption of
services
8 Transition of CHS to PHSA
BC Correctional Centres
There are 10 provincial correctional centres in BC
9 Transition of CHS to PHSA
BC CorrectionsOver 18,000 inmates
admitted to BC correctional centres per
year
90% male, 10 % female
27% aboriginal (50% of women are aboriginal)
Aging population (40% in those over 50 years since 2008)
High risk, complex population
Physiological age is 10 – 15 years older than expected
Average daily count of 2,734 incarcerated
persons (2016/2017)
Maximum length of sentence in the provincial correctional system is two
years, less a day
Average LOS for remand: 38 days
Average LOS for sentenced: 59 days
10 Transition of CHS to PHSA
Chronic Disease
HIV rates among incarcerated persons are
approximately 5%
Hep C rates among incarcerated men
are 31-33%
Hep C rates among incarcerated
women are 40%
TB rates among incarcerated persons are
approximately 21%
11 Transition of CHS to PHSA
Mental Health & Substance Use
• Persons presenting with mental health problems at admission doubled from 1996/97 to 2010
• 60% have a diagnosed mental health and/or substance use disorder
• Clients with a substance use or concurrent disorder serve longer sentences
12 Transition of CHS to PHSA
ScopeIn
Sco
pe
•Primary medical and nursing care•Mental health and substance use
services•Urgent care and basic emergency
response•Selected public health services•Urgent dental care•Health-related discharge planning•Pharmacy services•Lab and x-ray imaging services•Coordination of specialized
services•Occupational First Aid Out
of S
cope
•Health services for clients transferred to other provinces
•Regular medical care for BC Corrections staff
•Medical, nursing or mental health care for clients once released from custody
13 Transition of CHS to PHSA
Project Governance Structure
Project Executive Committee (ADMs/VP)
Communications & Change Mgmt
Project Steering Committee
Clinical
Facilities, Equipment, Emergency Planning &
Technology
Human Resources
Quality, Safety & Risk Management
Legal
14 Transition of CHS to PHSA
2017 Transition Timeline
15 Transition of CHS to PHSA
Clinical Services PlanEq
uiva
lenc
y • Health services delivered in correctional centres will provide the same level of access, equity and quality as those services available in the community
Auto
nom
y • Legal responsibility for health care operations will remain autonomous from corrections administration and oversight
Inte
grat
ion • Services will be
integrated with the PHSA, RHAs FNHA to promote seamless transitions and ensure continuity of care
Colla
bora
tion • Health services
and BC Corrections will work collaboratively with one another to ensure individuals’ health needs are met
16 Transition of CHS to PHSA
Key Enhancements to the Clinical Staffing Model• New positions introduced:
– Access & Transition Nurses
– Mental Health Nurses– Concurrent Disorders
Counsellors• Increased resources to
support the delivery of Opioid Agonist Therapy (OAT)
17 Transition of CHS to PHSA
Key Enhancements to Clinical & Corporate Supports• Ready access to lab, clinical
pharmacy, and diagnostic imaging• Chronic and infectious disease
management• Standardization of policies,
procedures, protocols• Structures in place to support:
– Professional practice– Patient safety– Quality improvement– Risk management
18 Transition of CHS to PHSA
Recruitment & Orientation
New leadership team
Over 300 permanent and
casual direct care positions recruited
Contracted physicians,
psychiatrists, radiologist, x-ray
technologists, dentists, and psychologists
Multiple orientation and
welcome sessions hosted across the
province
19 Transition of CHS to PHSA
Facilities & Equipment• Renovations and upgrades to
clinical space• Replacement or repair of clinical
equipment• Detailed technology analysis, plan,
and implementation: • Network infrastructure• Telephony• Clinical and business
applications• Telehealth/Telemedicine
• New emergency response plan
20 Transition of CHS to PHSA
Quality, Safety & Risk Management
• Policy review and revisions
• Risk assessment completed
• Identification of key performance metrics
• Evaluation framework
21 Transition of CHS to PHSA
Communication & Change Management
Joint communication plan and issue escalation protocol
Monthly newsletter updates to CHS and BC Corrections staff
Health Services Managers and other staff invited to participate in ongoing leadership and skill development
22 Transition of CHS to PHSA
Legal• MOU between MoH and
MPSSG• Operating Agreement
(including clear division of responsibility)
• Legal support required for:– Union negotiations– Transfer of assets– Contract development
23 Transition of CHS to PHSA
Partnership with BC Corrections• Collaboration with BC
Corrections partners is vital to safety and security
• Work as a team to provide safe, efficient care – Integrated Correctional
Health Care meets monthly
– CHS leadership attend BC Corrections management meetings
24 Transition of CHS to PHSA
Key Achievements: Virtual Health• 3 Telemedicine carts available for
delivery of primary care services:– Nursing and physician staff
trained– Clinical tools include a wound
camera/otoscope– Introducing and evaluating a
new Telesteth• Additional Telehealth services
include TransCare, TeleOAT, Telepsychiatry and access to an Infectious Disease Specialist
25 Transition of CHS to PHSA
Key Achievements: Opioid Agonist Therapy (OAT)• Additional OAT resources
– OAT nurses– OAT physician clinics
• Eliminated wait times for OAT initiation
• Reduce barriers to OAT and increase efficiency and safety of medication administration
• Currently over 900 clients on OAT at any given time (30-35% of all CHS clients)
26 Transition of CHS to PHSA
Key Achievements: Opioid Agonist Therapy (OAT)
27 Transition of CHS to PHSA
Key Achievements: Transitions in Care• Access & Transition Nursing
positions added• Project underway to establish
5 Community Transition Teams– Care coordination &
connection to services– Staff include Social
Workers and contracted Peer Support Workers
28 Transition of CHS to PHSA
Key Achievements: Staff & Culture
Correctional Health Services
We declare Correctional Health Services world class leaders in correctional healthcare where recovery is a reality.
We commit to a collaborative approach to the delivery of integrated, inclusive and holistic service.
We stand for respect, dignity and trauma-informed care.You can count on us for compassionate care for successful re-integration.
You can count on us to lead the way in partnership.
Correctional Health Services: achieving a gold standard of care and service
29 Transition of CHS to PHSA
Challenges• Quality of service does not
yet meet Accreditation Canada standards
• Providing medications to a large population with high turnover
• Reducing stigma• Reducing opioid overdose
and overdose death post release
30 Transition of CHS to PHSA
Opportunities• Window of opportunity to
reach a vulnerable population:– MHSU and primary care
supports– Management of chronic
conditions– Dental care– Pain management
• Enhancements to pharmacy services
• PHN reconciliation to improve continuity of care
31 Transition of CHS to PHSA
Summary• Transition completed successfully
despite aggressive timelines• Significant achievements:
– Mental health and substance use (including OAT)
– Transitions in Care– Virtual Health
• Strong working relationships with BC Corrections
• Vision of achieving a gold standard of service
32 Transition of CHS to PHSA
Questions?
33 Transition of CHS to PHSA
Thank you
Lynn [email protected]
Andrew [email protected]
Nader [email protected]
