3 | Key observations and concerns within this group reported complex, and often worsening, physical and mental health issues and described significant delays in receiving treatment. It is not unreasonable to expect that the reason for their transfer to Australia should have informed the level of health care services available at the hotel APODs. The following observation previously made by the Commission with respect to this particular cohort continues to be relevant in this context:69 It is of significant concern that many refugees and asylum seekers transferred to Australia for the specific purpose of medical treatment and/or assessment have not received the health care they require in a timely manner. In the Commission’s view, the health needs of this group differ significantly from those of people in the Australian community, and those of other groups of people in immigration detention. As outlined above, they were transferred to Australia for medical reasons, and many waited long periods in Nauru and PNG for proper assessment and treatment of their health conditions prior to their transfer to Australia. The IHMS health services in both the Brisbane APOD and Melbourne APOD provided for on-site nurse-led care from Monday to Friday with, for example, a registered nurse being present at the Brisbane APOD from 7am – 7pm on these days. A general practitioner and mental health nurse were both available on-site 2-3 days per week, with a psychiatrist available as needed. Outside the onsite operating hours of the IHMS health service, Serco staff at both facilities could call the Health Advice Service (a nurse-led phone advice service) if required. Facility staff could also request external emergency medical assistance whenever it was required. (a) IHMS health services All IHMS staff interviewed by the Commission considered that they had an appropriate level of autonomy in treating patients, and that any recommendations they made in relation to a person’s health were generally respected and facilitated by the ABF and Serco staff. A number of individual detainees at the hotel APODs gave positive feedback with regards to the IHMS staff, although others remarked on significant differences in procedures and the overall level of care depending on the individual staff member. IHMS is contracted by the Department Home Affairs to provide primary and mental health care services in Australia’s immigration detention facilities, including hotel APODs. As outlined in previous Community health providers who provided medical care to individuals following their release from hotel APODs described a range of common physical issues that they saw in former detainees that During the Commission’s inspections there were clear examples of individuals and teams who were striving to provide high quality health care services. However, there was also concerning evidence of suboptimal practices, and as outlined below a number of particular concerns about the health care services provided to those detained in hotel APODs. 38 inspection reports,70 the IHMS health service in each facility is ‘nurse-led’; nurses triage all requests for health care; all appointments are initially made with a nurse; nurses undertake detailed health assessments, planning of health care, delivery of treatments, ongoing monitoring of treatment and management of medicines; and the service is led by managers and team leaders who are also nurses. This is also the case with respect to the IHMS health service provided in hotel APODs.