Home Affairs Committee
Inquiry into Asylum
The governance and practice of healthcare in the Immigration Detention Estate frequently fails to reach minimally adequate medical standards. This is documented in numerous reports from Her Majesty’s Inspectorates of Prisons (1,2) and of the UK Borders Agency (3) as well as independent clinicians (4). It is substantiated by my experience of examining some hundreds of detainees as an independent doctor, which accords closely with that of numerous medical colleagues with whom I have discussed these matters.
My own observations include mismanagement of HIV infection, tuberculosis, paraplegia, a brain tumour, sickle cell disease, and serious mental illness, as well as neglect of evidence of torture and assault.
These failures have numerous and adverse consequences:
(1) Detainees are denied adequate clinical examination, investigation and referral, resulting in irreversible damage and possibly in a small number of cases, contributing directly to death. Denial or delay of necessary care has resulted in serious waste of resources in the NHS when patients are belatedly referred for secondary care or released into the community (as nearly 50% of detainees eventually are.)
(2) The “rule 35 process” for identifying persons who are unfit for detention is markedly dysfunctional. Its failures result in the continuing detention of persons who have (subsequently and often very belatedly) been found by the courts to have been unlawfully detained, and in some cases subjected to treatment found to reach inhuman and degrading levels, and compensated therefore at considerable public cost. These failures have also resulted from clinically negligent failure to recognise evidence of torture and administratively inability to admit of such evidence, with the effect of denying humanitarian protection to those who are entitled to it.
Parliament has mandated that responsibility for governance of healthcare in the immigration detention estate (IDE) shall be transferred from UKBA/Home Office to the Department of Health commencing April 1, 2013. This is a necessary (but not sufficient) condition for the establishment of adequate clinical practice in that jurisdiction, as it has proved to be following the equivalent process in UK Prisons. However, the transfer is apparently proceeding with considerable lethargy, as documented by the Department (appendix A—letter attached).
It will also be necessary to address the functions and ethics of the individual practitioners and of the systems in the IDE (appendix B). This will require discussions between those doctors, independent clinicians, ethicists and the General Medical Council, as well as both the Department of Health and the Home Office. Unfortunately, UKBA appear determined to ensure that nothing is done in this area for some years to come (see Appendix C). They justify this evasion with reference to the dilatory timetable for transfer.
If there is a single action the Committee could recommend to promote improvements in this area it would be to support a requirement that such discussions commence in the immediate future, with a view to advising the Committee of progress within less than one year.
I would be pleased to attend and give oral evidence to these points, should this please the Committee.
References:
(1) HM Chief Inspector of Prisons.
Inquiry into the quality of healthcare at Yarl’s Wood immigration removal centre (20–24 February 2006)
(2) HM Chief Inspector of Prisons.
Report on an unannounced full follow-up inspection of Harmondsworth Immigration Removal Centre (14–25 November 2011)
(3) HM Inspectorate of Prisons and Independent Chief Inspector of Borders and Immigration (HMIP and ICIBI) (2012)The Effectiveness and
Impact of Immigration Detainee Casework. A Joint Thematic Review.
(4) Tsangarides N. The immigration detention of torture survivors.
Medical Justice Network 2012.
http://www.medicaljustice.org.uk/images/stories/reports/secondtorturereport.pdf
Appendices:
(A) Email from Department of Health. (DoH timing—App A)
(B) Witness statement of Dr. Frank Arnold to the High Court of Justice. January 2013. (Frank Arnold statement—App B)
(C1) Letter from Dr. Frank Arnold to Ms. Karen Abdel-Hady (App C1)
(C2) Reply from Ms. Abdel Hady
Dr. Frank Arnold, independent medical practitioner
April 2013