An Invitation to Attend

MS Australia – ACT/NSW/VIC would like to invite you and your colleagues to a health education session aimed at assisting you to optimise treatment outcomes and develop important lifestyle strategies for people with multiple sclerosis (MS) and other chronic neurological disorders.

Full details in the attached flyer [DOC: 250KB]

Please find attached: The Collective Perspective: Aug-Sept 2011 [PDF: 4.3MB]

• On 12 August ACT ANF Members voted to accept ‘in-principle’ the ACT Government pay offer of 3.5% p.a. over a two year agreement backdated to 1 July.
• The final Government offer removed the intended cuts to the Qualification Allowance and included positive changes for CDNs, AHCs, APNs and the introduction of an EN2 personal classification.
• The ACT ANF is working with the Health Directorate to finish drafting the EBA as soon as possible.

• Once finalised the proposed agreement will be made available to all Public Sector Nursing & Midwifery staff.
• There will be information sessions in respect of the draft agreement and staff will have a minimum of 7 days to consider the proposed EBA. A ballot of all Public Sector Nursing and Midwifery employees will then be conducted.
• If the agreement is accepted by staff it will then be sent to Fair Work Australia for approval. If approved by Fair Work Australia the EBA will then come into effect and the pay increases and associated back pay will be implemented shortly after.
• Although the ACT ANF is unable to provide an exact date for the completion of the EBA the ACT ANF is hopeful that it will be complete by December. The ACT ANF will keep members informed of any significant delays.
• Meetings will be held and surveys conducted in the near future to compile a log of claims for the next round of bargaining.
• Please contact the ACT ANF to arrange a time for the organiser to visit your ward/area to discuss any industrial issues or concerns you may have.

MEETING THE CHALLENGE OFBLOOD BORNE VIRUSES IN PRISON A REPORT BY THE PUBLIC HEALTH ASSOCIATION OF AUSTRALIA July 19 2011 ACT ANF RESPONSE SUBMISSION 7 SEPTEMBER 2011

Download this notice as a PDF file

The Australian Nursing Federation (ANF) was established in 1924. The ANF is the largest industrial and professional organisation representing nurses, midwives and assistants in nursing (however titled) in Australia, with branches in each state and territory. The core business of the ANF is the representation of the professional and industrial interests of its members, and the professions of nursing and midwifery. The ANF participates in the development ofpolicy relating to nursing and midwifery practice, professionalism, regulation, education, training, workforce, and socioeconomic welfare, health and aged care, community services, veterans’ affairs, occupational health and safety, industrial relations, social justice, human rights, immigration, foreign affairs and law reform.

As the ACT ANF represents the majority of nurses, midwives and assistants in nursing currently working in the ACT, and the majority of nurses currently working at the Alexander Maconochie Centre (AMC), the ACT ANF thanks you for the opportunity to provide comment in respect of the Public Health Association of Australia (PHAA) report: Balancing access and safety Meeting the Challenge ofBlood Borne Viruses in Prison.

In view of the fact that the nursing workforce employed at the AMC is not large, and the fact that the ACT ANF, while representing the majority but not all nurses working at the AMC, the ACT ANF has sought input from all nurses, members and potential members alike, who are employed at the prison. Members were contacted by email and asked to submit their responses to the report. Aconsultation meeting with members and potential members was held on 22 August 2011 to canvass the opinions of nurses working within the AMC. Nurses were again encouraged to provide any further responses to the ACT ANF to assist it in preparing this response. However, the views expressed within this submission represent the views of the ACT ANF and its members, particularly those members working at AMC.

The ACT ANF and its members are cognisant of the public health and infection control issues underpinning the proposal to implement a Needle and Syringe Program (NSP) at the Alexander Maconochie Centre (AMC).

However, the ACT ANF is concerned that the although the Burnet report recommended a number of harm reduction measures in respect of blood borne viruses, particularly in relation to tattooing and piercing, and these, like recommendation 69, have been noted by the ACT Government, it is recommendation 69 which has taken precedence in respect ofhow this recommendation could be implemented within the AMC. Of additional concern is the fact that although the Terms of Reference provided to the Public Health Association ofAustralia (PHAA) sought information on the delivery of needle and syringe programs within custodial settings, the preferred recommendation presented by PHAA is that a supervised injecting room be established within AMC, either operated by an external agency (within the Health Centre) (option 3B) or operated by ACT Health/Nursing staff (within the Health Centre) (option 3A). It would therefore appear that this preferred option, although incorporating a NSP within its scope, exceeds both the terms of reference provided to PHAA and recommendation 69 of the Burnet report.

As previously stated, the ACT ANF and its members are well aware of the public health and infection control principles underlying the proposal to implement a NSP within the AMC. Unfortunately, none of the proposed models are acceptable to the majority of members currently employed at the AMC.

Examples of comments elicited from nurses during consultation are provided below:

1. Whilst I appreciate the ideals of harm minimisation I must say up front, most definitely and with firm conviction that I am totally and completely against any form of needle exchange program, within the prison environment.
2. I do not personally support Michael Moore’s proposal to operate an injecting room (model3a, 3b) for Justice Health Clients within the Hume Health Centre for the following reasons:
•  The Hume Health Centre operates on a community health centre model and focuses on a primary health model of care.
• A NSP within the health centre will have a huge impact on the way we currently conduct business.
• Clients self refer to several multidisciplinary clinicians that operate from the health centre 7 days per week. Both clients and clinicians maybe compromised whilst NSP practices are being conducted as extra resources (physical and human) will need to be allocated to this program. I am not aware that the opinions of these other clinicians outside of Justice Health have been sought.
• There is currently not enough space in the health centre to conduct routine health service delivery. I would not support any space in the health centre being used for this purpose at the expense ofcompromising current spaces within the health centre.
3. I support very strongly an NSP outside ofthe health centre for the following reasons. (Model yet to be identified)
• Infection control is core businessfor all health professionals. Harm minimisation is the model all health staffpromote when working with clients with substance misuse issues. Whilst I do not support the use of illicit drugs I support that IVD users should have access to clean injecting equipment.
• All Justice Health nurses are aware that there are regularly drugs in the AMC and the prisoners operate a dirty needle and syringe exchange amongst themselves.
• 80% of our clients are IVD users. 60 %have Hep C. The majority of them have contacted it by sharing drug injecting equipment; most in the NSW prison system. 60% of our clients report using a Community based NSP’s (ACT Population Health Inmate Health Survey 2010).
• Addiction is very complex and the nature of the addicted client is that they will take risks at whatever cost.
• It is impossible (ACTCS have acknowledged this) to keep drugs out of the AMC without resorting to very draconian measures e.g. strip searching and searching oral cavities and orifices including staff e.g. nurses. This is totally unacceptable and not a practice that Human Rights Commission supports.
• Our clients are a very vulnerable marginalised members ofthe community and all attempts to provide them with a system that will not only help prevent the spread of BBV’s but also make available the opportunity for clients using drugs to be identified by health staff NGO’s and provide the support and treatment options that they may require.
• By introducing an NSP it will help to present a framework where ACTCS may move to the “Harm Minimisation model” that is currently supported by the AFP and other law enforcing agencies.
4. Unless there is a change in legislation, it is counter intuitive to encourage and support drug use in AMC. Not enough staff, health and corrections; or space to properly implement program.
5. Screening for blood borne diseases and infections; at admission then 3 months later after incubation period as to determine spread and transmission rates in AMC.
6. The proposal represents something being offered in AMC that is not offered in the community. Alternative harm minimisation programs need to be exploredfor AMC before looking at implement NSP and other ways to stop infections need to be examined. Eg. Tattooing.
7. Safe, supervised injecting is the best way.
8. NSP could send a mixed message to the clientgroup about drug use. Models proposed are a well meaning attempt to address health issues however there is no way of understanding or controlling drug use inside the facility.
9. I support a NSP. There is an NSP going on right now, unregulated, illegal, and unhealthy-dirty. Infection control is a key concern. A successful exchange or supervised injecting program relies on some level of trust from clients; best practice shouldn’t be governed by the lowest common denominator.
10. The safe injecting room within AMC models would be a drain on resources.
11. Exchange issues – actually getting dirty needles out of system.
12. Anonymity issues for clients wanting to take part in NSP.
13. For staff, a question of choice – do staff have the right to object to being involved in NSP on moral grounds? If NSP was a community service, it is assumed that staff would be working there voluntarily. Not the same degree of choice for AMC staff
14. Control issues, a 1 for 1 exchange doesn’t limit needles being smuggled in. Syringes are worth money, have become a commodity in AMC – there will be clients seeking to profit. I support the idea, but not the proposed models.
15. Security and syringe control issues. There is no guarantee or way to monitor that the person exchanging the needle is actually using drugs. Instead the client may be being stood over by someone else. Control of needle numbers in prison is very hard to monitor.
16. Difficult to encourage client uptake of the program when nurses are supposed to be accompanied by a guard at all times: anonymity issues.
17. Resource intensive for the custodial officers, constantly maintain presence with health staff and maintains security. Staffing concerns.
18. I, as a Nurse in a prison setting, am totally dependent for my safety and security on will be compromising my safety and that of the officers. Also other prisoners have told me of their fears when prisoners use drugs.
19. Drug use and drug taking is illegal, and I won’t be involved with any activity that I perceive as actively encouraging drug use within a prison setting.
20. A safe injecting room is not available anywhere else in the ACT so why would a service be provided for prisoners that isn’t available to any other illegal drug user in the community?
21. I note the report, refers to pages 146-147 of the Burnet 2011 report, asserting that there is “overwhelming support for an NSP to be implemented at the AMC. Health staff from the prison also strongly supported the introduction of NSP services”. If this statement is designed to imply total support by health staff, then, in my opinion, this statement is inaccurate. To my knowledge, and from limited discussions with other nurses within the Hume Health Centre, it appears there has been little if any, open discussion on the issue, and informal conversations I have with some of my colleagues working at the Hume Health Centre indicate that that opinions range from total support, to total opposition, and everywhere in-between, including uncertainty.
22. Should nurses currently employed at the Hume Health Centre, be directed to administer a NSP, I urge the ACT Government to implement an option which includes the option of voluntary participation by nurses at the Hume Health Centre.
23. I do the BBV’s and I see all too well the problems associated with IVDU in the AMG. Although an injecting room is low on my agenda and would not be my preference there has to be a way to deliver a NSP to our clients. One for one would be my preference with a confidential register to track all outs and returns. A one for one distribution. Run by one person on set hours or days. Clients have also put this model forward.
24. The numbers here are extreme and we owe it to our clients and ourselves to provide clean equipment. I feel that Mr Moore although wanting to do right has lost sight ofthe big picture. I do hope that someone out there sees that a NSP can work and really it’s simple, just get on with it. No more debate someone listen and do.

As can be seen from the comments above there are a number of quite divergent views expressed by nurses currently working at the AMC. As all the proposed models, excluding NSP Modell (Vending Style Machines), require the support and assistance of nursing staff and/or the utilisation of the Health Centre resources, the ACT ANF considers that their views need to be given considerable weight in any planned implementation of a NSP at the AMC. What is apparent is that currently nurses employed at the AMC do not support the establishment of a supervised injecting room at the AMC. Although a number of nurses have expressed the view that some form of NSP should be supported on infection control grounds or from a harm minimisation perspective, there is no consistently agreed model, and all models presented in the PHAA report have been rejected. Although nurses, for the most part, could see the value of the supervised injecting room model proposed within options 3B and 3A, they were very unwilling to support this model for a number of reasons. The reasons for this position are summarised as follows.

Members acknowledged that the supervised injecting room was probably the best way of implementing a NSP proposal. However, the consensus view was that this option went well beyond what is required under the ACT Corrections Management Act 2007 which states that:

The Chief Executive must ensure that-

1. a) detainees have a standard of health care equivalent to that available to other people in the ACT; and b) arrangement are made to ensure the provision of appropriate health services for detainees; and c) conditions in detention promote the health and well being ofdetainees; and d) as far as practicable, detainees are not exposed to risks of infection.

Members considered that as currently there is no supervised injecting room, along similar lines to that available in King’s Cross, Sydney, NSW; the proposal went well beyond providing detainees with “a standard of care equivalent to that available to other people in the ACT.” Further, members considered that the tacit promotion of the continued use of intravenous illicit substances was contrary to conditions in detention which “promote the health and wellbeing of detainees”.

Therefore the key points raised by ACT ANF members were:

• The ACT ANF and its members understands the NSP proposal from a public health perspective, but do not consider that any of the models presented by PHAA are acceptable from an employee safety and moral perspective; lack the collegial support of other AMC employees; places detainees anonymity at risk and may subject some detainees at risk of having undue pressure placed on them to utilise the system on behalf of other detainees; and does not guarantee the eradication of unauthorised injecting equipment from the prison.
• If the primary concern of the proposal is to minimise and stem the transmission of blood borne diseases, what measures are being taken to address alternate sources for infection, tattooing and piercing, for example? The equity and advisability of offering a service at the AMC that isn’t offered in the community and that will not be able to be accessed by prisoners on release; and the mixed message such tacit approval of a destructive lifestyle gives when the emphasis should be on health promotion and rehabilitation.
• Issues regarding resources: health and custodial staffing, as well as physical space at AMC, especially given the limited availability of health facilities.
• Logistics of clients utilising a safe injecting room or NSP and being able to maintain anonymity was not considered feasible. A number of members expressed the opinion that even if these facilities were provided, clients would not use the proposed models.
• The proposed models do not address needle exchange usage or necessarily control the number of needles present in the AMC. There is no way, other than the adoption of Models 3B or 3A, that can guarantee that the “exchange” syringes and needles would not be used as currency within the prison, and would only be used once or by a single user and for the intended purpose. The 12 hour lockdown period at night provided ample opportunity for the unsupervised use of injecting equipment by individual detainees. As needles are a valuable commodity inside the facility, regardless of the number of “exchange,” legal needles and syringes present in the AMC, there will continue to be a number of illegal and dirty needles and syringes remaining within the prison.
• Concerns regarding staffs right to choose or decline to participate in the program. Members considered that staff working within a community setting would be able to choose their workplace based on the duties required by the workplace, this would not be possible for staff working at the AMC and many staff would need to consider their continued employment at the AMC if they were unable to conscientiously object to participating in the program on moral, religious or conscience grounds.

The ACT ANF, having considered the PHAA report and canvassed the opinions of nurses currently employed at the AMC, is unable at this time to support any of the recommendations outlined within the PHAA report. The ACT ANF and its members would be very interested in considering alternative needle and syringe exchange programs on a one for one basis, provided that the anonymity of the detainees could be guaranteed, and the utilisation and disposal of the injecting equipment could be assured. In the meantime, the ACT ANF recommends that additional resources be allocated to health promotion, and the detection of contraband within the prison.

Jenny Miragaya Branch Secretary

• A meeting of public sectors members on Friday 12 August voted to accept ‘in-principle’ the ACT Government pay offer contingent on workload management entitlements being fully implemented across the entire Public Sector.
• In the Minister’s own words… “it is my expectation that all of the provisions will be appropriately applied, and I am happy to commit the Government to working with the ANF and staff to ensure that this is the case.”
• Members in demonstrating their strength, commitment and resolve throughout the bargaining process have placed the ACT Government on notice, that they need to be properly valued and their concerns properly addressed. Although in this instance, members were not required to take Industrial Action, it was only by seriously considering this option, that the government was compelled to revise their offer and commit to maintaining existing entitlements.

• The Minister needs to honour her commitment to properly staff the public sector. The ACT ANF needs your help to ensure that this commitment is kept.
• Please keep the ACT ANF office informed of incidents of understaffing and excessive workload. Please report specific incidents of dangerous understaffing to the ACT ANF through a Critical Incident form, as well as completing a RISKMAN.
• While this may feel like more paperwork, consistent reporting of understaffing to the ACT ANF can have positive effects and has led to staffing improvements in many areas of the public sector.
• The ACT ANF also needs delegates and activists. If you are interested in becoming an ANF rep for your workplace or would like more information on becoming more actively involved within the branch please contact the ACT ANF office.

• The ACT ANF will work with the Health Directorate to finish drafting the EBA as soon as possible.
• The final draft Agreement will then be made available to all Public Sector Nursing/Midwifery staff. There is also likely to be a series of information session in respect of the draft agreement. A minimum of 7 days consideration will then be available for staff to read through the draft and ask question in respect of the draft in order to determine whether or not to accept or reject it. A ballot of all Public Sector Nursing and Midwifery employees will then be conducted.
• If the agreement is accepted by staff it will then be sent to Fair Work Australia for approval. If approved by Fair Work Australia the EBA will then come into effect and the pay increases and associated back pay will be implemented shortly after.