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| IHMS, the healthcare giant at the heart of Australia's asylum system – explainer | IHMS, the healthcare giant at the heart of Australia's asylum system – explainer |
| (7 months later) | |
| Related: Fraud 'inevitable' over asylum seeker health targets, leaked documents show | Related: Fraud 'inevitable' over asylum seeker health targets, leaked documents show |
| Guardian Australia is investigating how asylum seekers in Australia’s care receive medical and clinicalcare. Services in immigration detention centres are delivered through a complex web of outsourcing. Here’s everything you need to know about the system and how it works. | |
| How are Australia’s immigration detention centres run? | How are Australia’s immigration detention centres run? |
| Following the lead from many other countries around the world, Australia has tasked private contractors to deliver services in detention centres. This is partly because it’s seen as more cost effective, and places a lower burden on the government than to be constantly monitoring and running these facilities. It’s also politically convenient, adding an extra layer of insulation to particularly sensitive areas of government policy. | Following the lead from many other countries around the world, Australia has tasked private contractors to deliver services in detention centres. This is partly because it’s seen as more cost effective, and places a lower burden on the government than to be constantly monitoring and running these facilities. It’s also politically convenient, adding an extra layer of insulation to particularly sensitive areas of government policy. |
| Detention centres on the mainland, Christmas Island, Manus Island and Nauru have separate contracts, and are generally broken down by service type. While there are dozens of contractors and hundreds of subcontractors, a few big players dominate the field. | Detention centres on the mainland, Christmas Island, Manus Island and Nauru have separate contracts, and are generally broken down by service type. While there are dozens of contractors and hundreds of subcontractors, a few big players dominate the field. |
| Who provides healthcare to asylum seekers in Australia’s care? | Who provides healthcare to asylum seekers in Australia’s care? |
| Healthcare services are provided to asylum seekers by International Health and Medical Services (IHMS), which provides medical assistance across all mainland detention centres in New South Wales, Victoria, South Australia, Western Australia, Queensland and the Northern Territory, and on Christmas Island, Manus Island and Nauru. Currently around 3,000 people are held in detention centres and get their healthcare via IHMS. | Healthcare services are provided to asylum seekers by International Health and Medical Services (IHMS), which provides medical assistance across all mainland detention centres in New South Wales, Victoria, South Australia, Western Australia, Queensland and the Northern Territory, and on Christmas Island, Manus Island and Nauru. Currently around 3,000 people are held in detention centres and get their healthcare via IHMS. |
| The company has held successive contracts with Australia’s immigration department since 2009, that now total more than $1.6bn. In December 2014 it won a $438m contract to continue its management of health in onshore detention centres and is set to continue in that role until 2019. | The company has held successive contracts with Australia’s immigration department since 2009, that now total more than $1.6bn. In December 2014 it won a $438m contract to continue its management of health in onshore detention centres and is set to continue in that role until 2019. |
| Related: Asylum seeker healthcare firm's reports included wrong data – internal briefing | Related: Asylum seeker healthcare firm's reports included wrong data – internal briefing |
| Who is behind IHMS? | Who is behind IHMS? |
| The Australian entity, whose headquarters is in Sydney, is wholly owned by International SOS (Australasia). This company is also the broader umbrella company that specialises in a range of different medical services. | The Australian entity, whose headquarters is in Sydney, is wholly owned by International SOS (Australasia). This company is also the broader umbrella company that specialises in a range of different medical services. |
| International SOS employs about 11,000 people worldwide, of which half are medical professionals. It told the Financial Times earlier this year that its biggest client was the US military. The firm was recently deployed in Vanuatu after cyclone Pam, and has a long history of evacuating victims. | International SOS employs about 11,000 people worldwide, of which half are medical professionals. It told the Financial Times earlier this year that its biggest client was the US military. The firm was recently deployed in Vanuatu after cyclone Pam, and has a long history of evacuating victims. |
| International SOS (Australasia) is in turned wholly owned by a Singaporean company, AEA International Holdings. This is touted by International SOS as its ultimately holding company, and the group of other affiliated companies; Aspire Lifestyles, MedAire, Response Services Australia and RMSI. | International SOS (Australasia) is in turned wholly owned by a Singaporean company, AEA International Holdings. This is touted by International SOS as its ultimately holding company, and the group of other affiliated companies; Aspire Lifestyles, MedAire, Response Services Australia and RMSI. |
| Who runs AEA International, and where did they come from? | Who runs AEA International, and where did they come from? |
| AEA International was founded by Pascal Rey-Herme and Arnaud Vaissié in 1985. According to International SOS, the venture began as an organisation designed to give urgent medical assistance during crises: | AEA International was founded by Pascal Rey-Herme and Arnaud Vaissié in 1985. According to International SOS, the venture began as an organisation designed to give urgent medical assistance during crises: |
| Related: 'Significant risks' to health of asylum seekers in firm's failure to meet targets | Related: 'Significant risks' to health of asylum seekers in firm's failure to meet targets |
| While working at the French Embassy in Jakarta in the early 1980s, Pascal Rey-Herme, a French doctor, became aware of the need to deliver international standards of healthcare to the wider expatriate community and to international organisations in the region. | While working at the French Embassy in Jakarta in the early 1980s, Pascal Rey-Herme, a French doctor, became aware of the need to deliver international standards of healthcare to the wider expatriate community and to international organisations in the region. |
| Together with his childhood friend Arnaud Vaissié, who had been in the United States managing a subsidiary of a large German financial group, they set up a business to provide international standards of medical care and emergency medical assistance in southeast Asia. | Together with his childhood friend Arnaud Vaissié, who had been in the United States managing a subsidiary of a large German financial group, they set up a business to provide international standards of medical care and emergency medical assistance in southeast Asia. |
| Both men remain directors of AEA International, along with a truly global cast of board members; Michael Selby, Claude Giroux, Jean-Marie Josi, Greg Tanner, Alfonso Pallavicini and Chong Florence. | |
| The share structure of AEA International is extremely complex. By far the three biggest shareholders are another entity named International SOS Holdings, based in Singapore, Forte Group Limited, a company based in the British Virgin Islands, and AV Holdings International, a Belgium company. | The share structure of AEA International is extremely complex. By far the three biggest shareholders are another entity named International SOS Holdings, based in Singapore, Forte Group Limited, a company based in the British Virgin Islands, and AV Holdings International, a Belgium company. |
| How does Australia’s immigration department ensure healthcare standards are being met? | How does Australia’s immigration department ensure healthcare standards are being met? |
| When governments choose private companies to run detention centres, or prisons, or hospitals, it needs to monitor them. This is usually achieved through an extremely dense contract, as in the case of IHMS. A performance management framework governs how the immigration department assesses its performance. | When governments choose private companies to run detention centres, or prisons, or hospitals, it needs to monitor them. This is usually achieved through an extremely dense contract, as in the case of IHMS. A performance management framework governs how the immigration department assesses its performance. |
| Australia’s privately run detention centres are run through a carrot and stick system of financial penalties and incentives. Bad performance is met with financial penalties known as “abatements” and good performance is rewarded with “incentive”. | Australia’s privately run detention centres are run through a carrot and stick system of financial penalties and incentives. Bad performance is met with financial penalties known as “abatements” and good performance is rewarded with “incentive”. |
| The immigration department monitors IHMS through a range of daily, weekly and monthly reports. The organisation files a whole range of documents about health assessments, medical transfers, the completion of medical records and timely resolution of complaints that will help assess these financial measures. | The immigration department monitors IHMS through a range of daily, weekly and monthly reports. The organisation files a whole range of documents about health assessments, medical transfers, the completion of medical records and timely resolution of complaints that will help assess these financial measures. |
| Related: Immigration healthcare firm 'likely to fail' on child protection – briefing note | Related: Immigration healthcare firm 'likely to fail' on child protection – briefing note |
| What do these performance measurements look like? | What do these performance measurements look like? |
| As part of the performance management framework IHMS has to meet a series of key performance indicators. These span areas such as meeting GP appointments, filing incident reports about serious events, handling complaints, keeping records up to date and conducting health induction assessments. Many are focused on meeting deadlines and targets for these different areas. | As part of the performance management framework IHMS has to meet a series of key performance indicators. These span areas such as meeting GP appointments, filing incident reports about serious events, handling complaints, keeping records up to date and conducting health induction assessments. Many are focused on meeting deadlines and targets for these different areas. |
| In the event these target aren’t met, IHMS could “fail” a metric. The worse the breaches of metrics get, the potentially harsher the punishments are. Failing to meet at least a third of metrics in one month can lead to a “significant performance failure”, which has a higher penalty. If two significant performance failures are identified consecutively this is considered a “continuous failure” and warrants an even higher penalty. Six months of continuous failures entitle the department to terminate the contract. | In the event these target aren’t met, IHMS could “fail” a metric. The worse the breaches of metrics get, the potentially harsher the punishments are. Failing to meet at least a third of metrics in one month can lead to a “significant performance failure”, which has a higher penalty. If two significant performance failures are identified consecutively this is considered a “continuous failure” and warrants an even higher penalty. Six months of continuous failures entitle the department to terminate the contract. |
| An IHMS spokeswoman said in a statement: “Although the Performance Management Framework is a contractual requirement, IHMS had no motive to misrepresent performance reporting for financial benefit.” | An IHMS spokeswoman said in a statement: “Although the Performance Management Framework is a contractual requirement, IHMS had no motive to misrepresent performance reporting for financial benefit.” |
| Does IHMS have the option to excuse its performance? | Does IHMS have the option to excuse its performance? |
| Sometimes situations beyond the company’s control can happen, so the department created a scheme known as “excusable performance failures”. This was phased out though in favour of a different system known as “discretionary days” where IHMS could apply to be exempt from the performance metrics for several days at a time due to unforeseeable circumstances. | Sometimes situations beyond the company’s control can happen, so the department created a scheme known as “excusable performance failures”. This was phased out though in favour of a different system known as “discretionary days” where IHMS could apply to be exempt from the performance metrics for several days at a time due to unforeseeable circumstances. |
| What’s the problem? | What’s the problem? |
| For IHMS, one of the big issues has been how it balances the care of asylum seekers with its commercial goals. While they’re not always at loggerheads, documents obtained by Guardian Australia show that IHMS clearly sees the potential for conflict between these two objectives. | For IHMS, one of the big issues has been how it balances the care of asylum seekers with its commercial goals. While they’re not always at loggerheads, documents obtained by Guardian Australia show that IHMS clearly sees the potential for conflict between these two objectives. |
| In theory, the immigration department rewards IHMS for good performances, and punishes them for bad performance. But what the department consider good performance is not always on par with clinical objectives. Guardian Australia’s investigation has revealed a range of concerns raised by IHMS about the process. It has highlight both the tension between the department and IHMS, as well as the internal difficulties for the organisation as it grapples with how to provide care for asylum seekers as a private company, while answering to a government agency. | In theory, the immigration department rewards IHMS for good performances, and punishes them for bad performance. But what the department consider good performance is not always on par with clinical objectives. Guardian Australia’s investigation has revealed a range of concerns raised by IHMS about the process. It has highlight both the tension between the department and IHMS, as well as the internal difficulties for the organisation as it grapples with how to provide care for asylum seekers as a private company, while answering to a government agency. |
| In a response, a spokeswoman for the immigration department said: “The department has and continues to work with its service provider, IHMS to regularly review its reporting frameworks.” | In a response, a spokeswoman for the immigration department said: “The department has and continues to work with its service provider, IHMS to regularly review its reporting frameworks.” |
| She added: “On 11 December 2014, the department commenced a new contract with IHMS. The new contract includes a strengthened performance management framework which includes both abatements and incentives and focuses on detainee health and service outcomes.” | She added: “On 11 December 2014, the department commenced a new contract with IHMS. The new contract includes a strengthened performance management framework which includes both abatements and incentives and focuses on detainee health and service outcomes.” |