Provision of Healthcare in Detention
Healthcare in detention is commissioned from private companies and NHS trusts by NHS England. Healthcare in IRCs should be the equivalent to NHS services. However, our experience of visiting detainees as well as numerous reports from Her Majesty’s Inspector of Prisons (HMIP) and others, indicate serious problems in the standards of healthcare provided.
Detainees complain of a culture of disbelief towards them by healthcare staff: The culture of disbelief often leads inadequate healthcare. Detainees may not receive medicines or treatment they need. Sometimes detainees are taken from their homes in raids without warning and have little chance to pack their things or collect their medication. As a result, detainees may find that when they come into detention they do not have their medicines with them or only a short supply. This may include medication for HIV and painkillers for chronic conditions. See Detained and Denied, the clinical care of detainees living with HIV.
Loss of autonomy: Diabetics, and others with chronic diseases, who are used to managing their condition in the community, find that in detention they may be required to go to the healthcare clinic to get their medication, increasing their feelings of powerlessness and ability to manage their condition effectively.
Poor emergency care: When investigating deaths in custody the Prison and Probation Ombudsman has highlighted poor emergency care in IRCs. They have concluded that the staff is often inadequately trained and equipped to deal with medical emergencies.
Limited access to specialist care: In spite of the lack of appropriate care, some pregnant women are detained in Yarl’s Wood, often at risk to their and their babies’ health. See “Expecting Change: the case for ending the detention of pregnant women“. Detainees, who need specialist care, are taken to local NHS hospitals, though this does not always happen or at least in a timely fashion. In order for a detainee to be taken to an outpatient appointment, transport needs to be arranged. Problems with transport lead to repeated cancellations or postponement of medical appointments, so that frequently treatment for serious conditions is delayed or not received at all.
Missed appointments: Appointments can also be missed if the detainee is moved to a different IRC. Moving detainees between IRCs is common, often with no reasons given. If the detainee is waiting for a hospital appointment and their appointment is lost, the process has to start all over again at the next IRC. Medical records may not be available on arrival at the detention centre. When someone has an important medical appointment, the Detention Centre doctors and nurses should place the detainee on “medical hold” to prevent a transfer and the appointment being missed. However, this frequently does not happen.
Handcuffing and restraints: When taking detainees to hospital the IRC security staff often use handcuffs, even when the detainee is clearly very ill. This can be so upsetting for detainees they may refuse to attend as a result. HMIP have recommended that detainees should not be routinely handcuffed when escorted or during hospital appointments. Restraints should be applied only if a Risk Assessment indicates a specific risk of escape or a potential threat to the safety of the public or staff. However, professional guidelines in these circumstances are clear that the consulting doctor should request the removal of restraints and request guards to leave the room. If a doctor fails to act appropriately in relation to the removal of restraints and ensuring privacy during consultations, this will result in a breach of the patient’s right to dignity, privacy and confidentiality and can have serious consequences for the patient. In the case of Mr Alois Dvorzak, an elderly man who died while handcuffed on escort from Harmondsworth IRC, the Prison and Probation Ombudman found that his restraint amounted to a breach of article. See the PPO report.