Speech: Draft blood borne virus (BBV) management strategy for corrections

IMG_4561ALT
 

Katy’s speech at the Justice Health Symposium announcing a draft blood borne virus (BBV) management strategy for corrections, 15/8/12.

Thank you for the opportunity to speak with you this morning.

I’d also like to acknowledge that we gather today on the land of the Ngunnawal people, the traditional owners and I extend my respects to their elders past and present and also acknowledge the continuing culture and contribution they make to the life of our city and our region.

Just following up from what Michael (Moore) said there, I think it’s probably safe to say Michael that I took your seat Michael – in a nice way because you did retire – and then I’ve taken your job as well and there’s a few issues around that, that we can talk about another time.  I like to think that if Michael and I were in the Assembly together that we would have got along probably quite well and been able to work on areas of mutual interest, of which some of the matters we’ll discuss today are certainly some of them.

It really is a pleasure to be able to join you this morning.  There are some small bonuses of having a no-confidence motion called in you.  One is that it freed up the diary for the next 7 days and has allowed me to be here this morning.

I think the issues that you will wrestle with during today’s discussions are some of the most vexed and difficult ones that we deal with, as policy-makers, as health professionals and as advocates for equity, fairness and for change.

I believe many of the issues you’ll be discussing today must be viewed from a position of principle and perhaps it’s appropriate then that I start this morning by quoting from the preamble to the ACT Corrections Management Act, which starts with the quote “The inherent dignity of all human beings, whatever their personal or social status, is one of the fundamental values of a just and democratic society.”

Principles demand that we must see beyond the labels of “prisoner”, “remandee”, “inmate” and “criminal” and focus instead on the men and women who live behind those labels.  Men and women who have the right to the same health-care options and opportunities, the same culture of care, as you and I, and our children, and our friends and our neighbours do.

A position of principle requires us to leave emotion and politics to one side, and concentrate on the public-health policy outcomes we seek.

And surely the public-health outcomes we seek for members of our community who are spending a period of time in their lives in custody ought to be no different, no less, than they are for the rest of us.

As many of you in this room know, I have been trying to work a way forward for the management of Blood Borne Viruses in the AMC for some time now.  This is one of the most complex, emotive and fraught areas of health care in the justice system.  It probably shouldn’t be on any rational analysis of it, but it is.  And I think, if I could just take a moment to look at what has brought us here to where we are today.

The ACT Government’s original stance when the AMC was opened was to promote a drug free goal and to see if that could be delivered.  The former Chief Minister in many discussions I had with him, spoke of his desire to do something different at the AMC.  I think we can all say in the early time that its been opened we have been able to do a lot of things differently, but not everything.

The position was that we would open the goal without access to a Needle and Syringe Program and review the data 18 months on.

So we should also at this point acknowledge that we have a lot to be proud of in terms of the services that are offered at the AMC and that is a credit to the staff of corrections and health.  On my trips to the AMC to see the suite of health services that are offered, in the environment that they are offered, you can’t even compare it to what was on offer before, whether people were in Goulbourn Gaol or on remand at the Belconnen Remand Centre.  So I start from that point.

The data after 18 months was clear.  It showed very high rates of Hepatitis C; it showed evidence of injecting whilst in jail and evidence of injecting equipment. And it also found evidence of transmission of Hepatitis C within the prison environment.

So this was the evidence that came to the Government, I guess the next question was, what to do with this information.  I acknowledged that the situation was fraught – there were advocates on both sides of the debate – and strong advocacy on both sides of the debate.  Not only advocacy there was also issues about practical implementation and whether that could be done, regardless of a decision any government took.

Following this – I commissioned the Moore Report to look into how a needle and syringe program could work – and I would like to acknowledge that work that was done by Michael, very high quality work, he spent a lot of time on it and he presented the government with seven recommendations and we are releasing our response to the Moore Report today.

That presented the Government with options on the way forward and it did recommend the introduction of a needle and syringe exchange program along with several options of how we could proceed with that.

Following on from that I think I’ve met everyone and anyone who wants to talk to me about the management of blood borne viruses in a correctional setting.  I’ve met with Unions, health professionals, non government agencies, I’ve corresponded with a number of people over the issue as well.

And one of the issues that came up during all of those discussions– was people wanting an understanding of all of the responses to managing Blood Borne Viruses in a Gaol, not just discussion on one element of what that could be.

So in terms of my discussions across government, and acknowledging the work that the Health Directorate has done here, what we’ve done is put together a strategic framework for blood-borne virus management in the Alexander Maconochie Centre, and we are releasing that document today.

Now what that strategy does is outlines some principles, where we come from, goals of what we would like to achieve, priority areas for action, consultative processes – about how to get there – and also explaining the range of current services that are already offered.

Now as part of that strategic framework – one of the actionable priority areas – Action 1 (c) – as part of prevention and education section, includes the commitment for detainees having access to injecting equipment.

This will, when it’s delivered, operate alongside counselling, and current treatment options, including education.

The strategy proposes a trial of a one-for-one medical model exchange.  A medical officer will issue a clean needle only in exchange for a used one.  This addresses the correctional officers’ concerns that there would be an influx of needles into the gaol.

Under this model and based on the advice that I’ve had from the clinical staff at the Hume Medical Centre, a doctor would make a decision about whether it was part of that detainee’s best treatment program to have access to sterile injecting equipment and it could only be provided if used injecting equipment was returned.  I think that addresses that concern that had been raised.

Importantly, this model also offers the opportunity for medical staff to counsel the recipient about drug use, harm minimisation, and other available treatment options to end their dependency, with the aim of having as many prisoners as possible emerge from jail drug-free.

This model encourages access to treatment by medical professionals.  In many ways I’ve come to the decision that access to sterile injecting equipment should not be a decision taken by a politician, it should be a decision taken by a health professional, in this case, between the relationship, and the close and confidential relationship between a doctor and their patient.

Running alongside this, Corrections staff will concentrate their efforts on detecting and reducing the supply of illicit drugs in the AMC – the other crucial element of reducing harm.  Supply reduction activities include screening of visitors, the use of sniffer dogs and detection technologies, intelligence-based interception of supply, searching of detainees, cells and other areas, and targeted and random drug testing.  None of this will change under the implementation of a one-for-one model.

The strategy also talks about an implementation group to work through details of the strategy of the one-for-one model and I’ve already written to all relevant stakeholders to be part of this process, acknowledging very much the position I have taken all along through this, that we should as much as possible, even though there are strong views, work collaboratively in the interests of the individuals who may or may not use this program.

Importantly, the trialling of a needle exchange does not mean we are throwing in the towel when it comes to drugs in the AMC, any more than pursuing harm minimisation programs in the area of tobacco use could be characterised as throwing in the towel in the search for a cure for lung cancer.

We can’t, in all conscience, reject an approach we know for a fact will work to reduce the spread of blood-borne viruses, just because we’d prefer the ground rules to be different.  They aren’t.  Politicians cannot in any good conscience, bury their head in the sand on this issue and hope that it will go away.  It won’t.  And as much as some politicians don’t like to acknowledge it – detainees in the AMC are our citizens too and they deserve our attention too just like any other citizen does.  Their time spent in the AMC is their punishment denying them access to full range of health services is something we currently impose on them in addition to that sentence.

Of course, the needle exchange trial will be just one element of the blood-borne virus strategy, as I’ve already said.

Other elements will include giving prisoners access to vaccinations against blood-borne viruses, as well as post-exposure prophylaxis, and comprehensive education and training for all AMC staff in relation to blood-borne virus transmission.

The strategy I have released today is timely, and necessary.  There have now been nine documented cases of in-custody transmission of Hepatitis C at the AMC.  I don’t believe it’s acceptable for a government and a community to simply shrug those nine infections away as one of the less savoury consequences of locking offenders up.

We can do better by members of our community – including those who offend against our standards and laws.

Controversial and difficult as this has proven to be, and some will say that my announcement today 67 days out from election could be characterised as crazy brave.  There are some significant implementation decisions to be sorted out, but I’m not here to warm a seat, I’ve been working on this for years and now is the right time to take the next step.

Obviously, there are challenges that remain.  Our own survey of prisoners in 2010 found a high proportion of those in custody had a history of poor mental health, as just one example, and extremely high levels of tobacco smoking and these are significant health challenges that we all need to keep focused on as well.

I know this is one of the issues on your agenda today, along with the particular vulnerability of Aboriginal and Torres Strait Islander inmates, and the complexities of maintaining linked-up health services for those transitioning from prison back into the broader community.

It is very clear that there is much, much, much more work ahead of us.

Can I just take this opportunity to thank a lot of people who have assisted getting here today.  To the Health staff and the Corrections staff who have been extremely generous in time they’ve given me, in talking with me about the concerns and their strong feelings about the right way to proceed on this matter and their continuing preparedness to work with us on this journey.

To the Public Health Association, and in particular to Michael for his counsel and also his long held experience in this area has been of significant benefit to me.

To groups like ANEX; to ATODA; to the Hepatitis C Council and all the non government organisations who have come and met with me.  To the Human Rights Commission who has maintained their strong advocacy in relation to this.

And also again probably something you wouldn’t normally see 67 days out from the election, can I acknowledge Amanda Bresnan from the Greens who has also had a long standing interest in this issue, and when the times get tough it is nice to have someone stand next to you and take a rational line.

I know that there would be other people I’ve left off, and I certainly don’t mean to cause any offence because it certainly has been a collaborative piece of work.

It is true, and I’ll just finish on this, it’s true that by incarcerating an individual, we deprive them, for a time, of one of their fundamental human rights: the right to liberty. But once we understand that a prisoner is sentenced to a term of imprisonment as punishment, rather than for punishment, we must also concede that the bulk of that individual’s rights remain intact and unviolated – including the right to equitable health care.

Thank you very much.