Post by Sarah Turnbull, Centre for Criminology, University of Oxford

Over the past year of fieldwork in four immigration removal centres (IRCs) in the UK, the issue of healthcare regularly emerged as a problem area for the detained women and men with whom I spoke. I was often told that the healthcare services in detention were substandard compared to services available outside, and that paracetamol was used as a panacea for all sorts of ailments, from headaches to upset stomachs to sleeping difficulties. There was often confusion among detainees around the services and treatments to which they were entitled, and many expressed frustration at the lengths of time they had to wait to receive care. Previous research by Mary Bosworth has also highlighted detainees’ perceptions of healthcare as a measure of the quality of life in detention, with healthcare services emerging as an area of concern.

Enhanced unit at Colnbrook IRC (Photo: S. Turnbull)
At present, primary healthcare provision is sub-contracted by the commercial operators (Serco, G4S, Mitie, and GEO) and Her Majesty’s Prison Service to a variety of service providers, resulting in a lack of standardisation across the detention estate. Detainee advocate groups like Medical Justice, Bail for Immigration Detainees (BID), and the Association of Visitors to Immigration Detainees (AVID) have highlighted the challenges with the current system (see here and here), arguing for the National Health Service (NHS) to take over the commissioning of primary healthcare provision.

The current system is set to change―at least in England. Section 15 of the Health and Social Care Act 2012 enabled the Secretary of State to require NHS England to commission certain services, including those ‘for persons who are detained in a prison or in other accommodation of a prescribed description.’ The latter covers those who are detained in IRCs and other institutions managed by Immigration Enforcement, such as short-term holding facilities (STHFs). A Framework Agreement signed by NHS England and Immigration Enforcement in December 2013 sets out the relationship between these two organisations, and has enabled the movement towards NHS England commissioning primary healthcare services for IRCs and STHFs.

On Monday, 29 September 2014, I attended a workshop organised by NHS England and the Home Office on the commissioning of primary healthcare services across the detention estate. The purpose of the workshop was to share knowledge of NHS England’s commissioning approach, and to better understand opportunities for cooperative work between health providers and the detention estate, while identifying and addressing the key challenging areas of work. There was also a presentation of the results of the Health Needs Assessment (HNA) report based on research undertaken at all IRCs regarding healthcare provision and detainee perceptions of their health. This report highlights various challenges and areas of improvement for the provision of services in IRCs, as well as the need for further research on physical and mental health among detained populations.

The workshop highlighted the unique challenges of healthcare provision in IRCs and STHF, including:

  • Ensuring quality of care to a population characterised by a high rate of turnover as individuals move in and out of detention, and around the detention estate;
  • Providing effective services to a diverse population with different needs (e.g., foreign national ex-prisoners versus those who’ve just arrived in the UK);
  • Overcoming ‘cultural barriers’ that may prevent some segments of the detained population from accessing healthcare services (e.g., sexual health);
  • Addressing both acute and long-term health problems for individuals who may be removed or deported; and
  • Dealing with the interaction effects of high levels of emotional stress due to detention on detainees’ physical health.

As one practitioner at the workshop observed, access to healthcare in IRCs isn’t purely a clinical matter; there are many other factors that may either motivate or dissuade detainees from seeking treatment, such as the presumed impacts on pending immigration cases.

Reports from 2011 that detainees were denied life-saving drugs (Source: The Independent)
NHS England’s commissioning for Britain’s IRCs (minus Dungavel in Scotland) and STHFs is set to commence in April 2015. This move should bring about greater standardisation in terms of healthcare screening and assessments across the detention estate, thereby reducing the wide variations in primary healthcare provision that’s currently exhibited. The commissioning of healthcare services by NHS England is also believed to enable greater monitoring and reporting of emerging health issues, such as communicable diseases, among the detained population.

Based on my numerous conversations with those in detention over the past year, I hope that this move towards greater NHS involvement in the provision of primary healthcare in IRCs will address the concerns that detainees have raised in regards to the quality and range of care they receive.

To read more about healthcare and irregular migration, see the following posts:

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How to cite this blog post (Harvard style):

Turnbull S (2014) Changes to Healthcare Provision in Britain’s Detention Estate. Available at: http://bordercriminologies.law.ox.ac.uk/healthcare-provision-ircs/ (Accessed [date]).