Executive Summary

Background
"There are ten immigration removal centres in the UK where failed asylum seekers, illegal immigrants and ex foreign national prisoners are held prior to removal or deportation from this country. Seven of these are run by private organisations who sub contract with private healthcare providers for primary healthcare services. 
 
In 2006 HMIP were asked to report on healthcare in one of these centres following concerns about the management of the health of two detainees.
 
Included in the subsequent report were two main recommendations; that IRCs should be registered with the healthcare Commission; and that commissioning services should move to the NHS.
 
The Care Services Improvement Partnership was commissioned by the Border and Immigration Agency, the executive agency for the Home Office, to explore these recommendations further over a period of three months.
 
Method
CSIP looked at current evidence in reports for the BIA and research in healthcare provision internationally. A wide range of stakeholders were interviewed and all seven privately run IRCs and their host PCTs were visited to understand the factors that might negatively impact on delivery of services for detainees.
 
Findings
There are a number of factors which influence health and healthcare of detainees including:
 
• Fragmentation of information and failure of information to follow the patient throughout the asylum claim process. This makes it difficult for the BIA to know which failed asylum seekers are unsuitable for detention. 
• The short time scale that healthcare providers have to ascertain health needs as detainees move in, out and around the IRC estate.
• The reluctance of failed asylum seekers to seek help for a range of health needs such as HIV or mental health issues relating to their experience of fleeing violence or persecution.
• The lack of consistency of healthcare provision and clinical governance processes across the estate with variable use and development of:
   ~ Evidence based procedures and policies
   ~ Staff development and audit 
   ~ Review of healthcare provision against clearly defined outcomes 
 
PCTs have not necessarily commissioned secondary acre services to meet the needs of this group, though they are responsible for that commissioning.

PCTs experience of commissioning healthcare in prisons has been one of high expectations with minimal resources.
 
Moving funds and commissioning from the immigration estate into PCTs will not necessarily overcome these factors and might disadvantage detainees in areas where local health services are struggling to balance their finances. 
 
Recommendations
There should be: 

• A joint commissioning framework at policy level between DH and HO ad at operational levels between providers of the secure estate and PCTs. The immigration services would retain responsibility for the health of their inmates but supported by the expertise within the NHS
• A formal clinical governance process with the Home office, BIA, DH and NHS determining outcomes expected from services.
• An expert panel to advice on evidence based management of the conditions which occur in IRCs.
• Regular assessment of health need to support commissioning and service development by PCTs and IRCs. This should include assessment of the impact of the detention process itself on the health of detainees and how this might be minimized. This should include mental health needs and use of psychological therapies.
• PCT clinical governance committees should be actively involved in provision of services and support IRCs to provide high quality care to reduce the need for expensive secondary or tertiary care services.
• Formal arrangements to ensure information follows the patient in and out of the NHS, and across the asylum process including IRCs but also including reception and induction centres in the community. "

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