CLINICAL GOVERNANCE GROUP MEETING

Date: 18th April 2006                
Time: 10.30
Location: Wellington House, Waterloo SE1 8UG
Chair: Brian Pollett - HO

Present:  
Alan Hollett - HO
Simon Barrett - HO
Dr. Stuart Morgan
Dr. Mary Piper - DH
Susannah Nisbett - DH
Anne Richardson - DH
        
Apologies:   
Michael Swaffield - DH
Dave Goggins - HO

Minutes of last meeting
Minutes of last meeting approved.

Update from IND
Protocol for visiting doctors - BP - Protocol sent out and working OK.  Mary Piper requested a copy of Protocol.   ACTION - Dave Goggin to send.

Healthcare Commission
IRC registration is underway but is proving to be a slow process with only one centre having made its formal application.  This is being chased from our end.

SN explained how the HC categories are set out which has caused problems in terms of the categorization of removal centres. The Healthcare Commission will be merging with the Social care Commission and the Mental Health Act Commission. This is likely to provide an opportunity for them to revisit categorization in due course and SN will keep up a link with new Commission.

BP advised that IND has been renamed as Border and Immigration Agency (BIA).  There is no impact on the organization but the prison service will go into the Ministry of Justice.   We will need to develop more protocols with the new Ministry over time.

SB had said that the HPA is in the final stages of the process to approve
Guidance on dealing with chickenpox in removal centres and that he would be chasing HPA shortly.  In the meantime, the HPA are content for their draft revised guidance to be used on an ad hoc basis in consultation with local communicable disease control consultants.

Healthcare IT
AH said that work was still ongoing on this area.

Torture Allegations
The detention rules are that the medical practitioner at the centre reports to the centre manager and then it is fed back to the agency.  Rule 35 is the person making referral from doctor.  Doctor makes report then receipt of action.  Audit reports are made - receipt actioned.

An audit of the system by two Senior Directors of BIA looked at 21 cases.  In 17 cases the torture allegations had been made previously and were therefore already known to caseworkers.  In 3 cases the individuals concerned were facing third-country removal and one case was at its very early stages. It was also discussed that most of these cases would have been discounted because the majority of people in removal centres would have had their asylum claims dealt with.

Department of Health Update
SN said that there are some planned changes to the role of prison health and it is likely to be dealing with offender health issues which will include prisons, police, probation.

Provision of Disinfectant Tablets in Removal Centres
A short discussion about the effectiveness of having the above provision in removal centres.  It was agreed that this should be rolled out across the estate.  ACTION SB will take this forward.

Refeeding Guidelines
MP discussed the draft refeeding guidance and it was agreed that she would send some chapters to SM for his imput. Mike Stroud still had work to do on the guidance and he would have another meeting with MP after SM had made his comments.  The group felt that this is a good piece of work and is going in the right direction.

Transfer to hospital of mentally ill detainees
Anne Richardson joined us from the Department of Health as she is an expert in this area.

A discussion took place where it was agreed that doctors needed to be aware of their responsibilities and powers under the Mental Health Act. In addition BIA case workers and detention service staff need to be aware of the correct response to a situation when a person is sectioned under the Act (i.e. whether detention can/should be maintained or whether temporary admission should be granted.  SM suggested that there should be some simple guidance for removal centre healthcare practitioners and that he was willing to draft a brief fact-sheet.  Once agreed the fact-sheet could then be used as the basis for guidance to BIA staff.

Action SM and SB to take forward

Management of Drug Addicts
The group discussed how prison service deals with the management of drug addicts.  BP said that for the IRC estate this does not seem to be a major problem as it is for the prison service.  Even though we are taking more ex FNPs it seems that very few of them are on drug treatment programmes.  It was agreed that if someone comes into the IRC estate on a drug treatment programme then this should be continued where possible.   BP also raised the issue that not all centres held methadone and this created an issue in itself as the prescrbing of a controlled drug requires certain authorities but as this is not a major issue for the estate it was agreed that each case should be dealt with on an individual basis.

Hospital Attendance & Handcuffs
MP explained that she had been involved in prison service use of handcuffs on hospital appointments.  AH explained the process and the recent DSO which had been issued and said that the only time a detainee is likely to be handcuffed would be if there was a danger of escaping or assault. It was agreed that AH would talk to G4S and discuss the issue of removing handcuffs whilst in a consultation with a doctor.  This must be the starting point of any risk assessment. ACTION AH

Fitness of Detain (BID publication)
It was agreed that this publication had been discussed at a previous meeting and that the publication had been passed to the Health Care Steering Group for their perusal and actions if required.  The Clinical Governance Group felt there was no more they could add to this.

Any other Business
SB raised the issue of the new legislation about smoking in England which comes into effect on the 1st July 2007.  He explained that he was having discussions with DH and was awaiting confirmation that removal centres could be regarded as exempt as care homes.  When SB has received confirmation of this or confirmation that the ban will apply, he would write to centre managers on what action needed to be taken.