7 | Health Services 7.4 Out of hours health care services Onsite health services at YHIDC are provided at the medical clinic from 9:00am–5:00pm Monday to Friday. There are no health services on site out of hours, except for medication rounds. The clinical staff providing the medication rounds out of hours do not offer consultations for other matters. Outside of the medical clinic’s operating hours, Serco staff can call the Health Advice Service (HAS), a nurse-led phone advice service based in Sydney, if required. The HAS staff triage urgent calls, decide whether hospitalisation is required (and then arrange an ambulance if needed) or, in less urgent circumstances, can decide whether IHMS onsite can follow up the next day. The HAS also has access to a doctor for prescriptions. Access to the HAS is facilitated through Serco staff only and people detained cannot make direct contact. HAS staff may speak to the detained person on the phone; however, the HAS does not offer telehealth. Centre staff can also request external emergency medical assistance outside of the HAS whenever this is required. The staff offering the HAS service do not necessarily have site specific knowledge of YHIDC and its reliance on a partly volunteer ambulance service and a small rural hospital in Northam, which itself has very limited facilities. Many people the Commission spoke to advised that the out of hours service does not offer anything substantive, and that any medication prescribed takes a long time to arrive. Some reported that pain relief might be paracetamol, but there was only one dose given per request, so if pain continued, they could not access further medication. One man interviewed told the Commission that he had 38 dislocated a finger, leaving him in severe pain, and was not offered any pain relief before he arrived at the hospital, which took 3 hours. The Commission is concerned that the lack of access to healthcare out of hours presents a very significant risk to people detained. A general nurse-led phone line does not provide an adequate substitute and cannot be expected to respond to a major medical emergency or a mental health crisis. These concerns have also been raised by the Coroner’s Court of Western Australia.78 The Deputy State Coroner has noted ‘…a phone advice service after hours is a poor replacement, given the known high prevalence of mental health issues in detention facilities, as observed in other inquest hearings’.79 RECOMMENDATION 14: The Government and the Department must urgently address the lack of on-site healthcare out of hours in immigration detention and return to a 24/7 staffing model. RECOMMENDATION 15: The Department and IHMS must ensure that there is consistent, timely access to pain relief and other urgent/ unplanned medication needs at the centre across the whole out of hours and weekend period.