A man deliberately set fire to his mattress and clothes, and was taken to hospital in Surrey on Jan 31st, two weeks ago.

He is one of 426 men held at Brook House, one of the immigration removal centres (IRCs) at Gatwick. After being treated for smoke inhalation he was returned later the same evening, according to a G4S spokesman.

Crawley’s West Sussex Fire & Rescue Service put out the fire, and had ventilated the smoke damaged cell before leaving, all in 30 minutes.

Clearly it did not come to much,  but why did a man feel the need to set fire to the few possessions he has, and what happens next?

The G4S media spokesman said last week in connection with the fire, he was unaware of any standard health assessment or any procedures for the care of men after these incidents.

In 2010, only one year after its opening, the HM Chief Inspector of Prisons report based on an announced visit at Brook House Immigration Removal Centre [3] labelled the Brook House IRC as fundamentally ‘an unsafe place’.

The inspectorate found in 2010 and again in 2013 that the mental health failings were serious. Should it not be realistic to expect standard practices should already have been put in place since, for their improvement?

What will the recent multi-million contract for healthcare at a number of detention centres awarded by NHS England to G4S and separately in prisons mean for standards and continuity of their NHS care, and will improvements be put in place which work?

The multinationals working in our UK justice and home office systems, G4S [which manages Brook House] and Serco, haven’t exactly got track records which are equal to the ethical expectations the public has in their roles.

They also operate in Australia where Ministers have taken a hardline approach in defiance of human rights asylum conventions.

One year ago today, twenty-three-year-old Reza Barati was killed in an Australian immigration detention centre on Manus Island. In August 2014, police have reportedly charged two guards working for former camp operator G4S with his murder. A parliamentary enquiry found the violence was foreseeable.

Another man, Hamid Kehazaei did not get taken from Manus to receive adequate medical treatment quickly enough due to paperwork delays, and died in December, the Guardian reported.

Are there warning signs that the provision in England is heading in the same way and not just for IRCs but for detention and prison across the UK?

Do people needing healthcare get taken offsite quickly enough when needed in England? How have they responded to deaths in detention?

In the UK, the IAP on Deaths in Custody has produced a comprehensive statistical breakdown of all recorded deaths in broad state custody settings between 1 January 2000 and 31 December 2010.

The report included a focus on the deaths of people detained under the Mental Health Act (MHA).

Children have died in detention and men during IRC removals.
[For more detail, see the section below, Questions on the Staffing and use of Force in care]

The care and the responsibility for these IRC-held men, women and children may not be of interest to everyone in the UK.

But as the expansion of private contractors becomes the norm, any family in England who finds someone they love in any non-HMP run English prison might be touched by the values of these providers.

Should we demand that equal ethical standards, transparency of targets and procedures, and the provision of physical and mental health care, be for all, as basic human rights?

Must our state keeps awarding massive contracts to these massive multinationals?

Will we, under the cuts of austerity, see situations deteriorate further in the UK, to the Australian standard?

Will we look back and wish we had acted sooner?

These issues are not new and are well documented

Lord David Ramsbotham GCB CBE, Her Majesty’s Chief Inspector of Prisons – December 1995 – August 2001 wrote the foreword in the 2008 report by the Birnberg Peirce & Partners, Medical Justice and the National Coalition of Anti-Deportation Campaigns  [Outsourcing abuse 2008] in which he identified:

“a most unfortunate attitude, adopted by officials towards issues surrounding asylum and immigration, described by the Commission as ‘a culture of disbelief’.”

It seems this culture of disbelief is allowed to continue.

Yet despite years of evidence, the February 2015 Home Office response by today’s government only accepts in part, some of the issues raised and recommendations in the Tavistock Institute Review [2] of IRC mental health care.

These include indefinite detention and the impacts on mental health, and a proposal of cultural change to speed up processing times.

As this is considered, I wonder will any change aimed at reducing indefinite detention manage to be designed in such a way as to also future-proof thorough and proper processing procedures?

In the meantime, detainees and prisoners are protesting via the few channels they have.  Self harm, starvation and setting things alight.

So what can we, the Public do?

If you think this matters but know little about it, we can get informed, or we can ask that our MPs intervene on our behalf.

We can support those who work or campaign in this area, like AVID [see on social media #Time4aTimeLimit and @DetentionForum

I wonder if those more informed, perhaps your local Red Cross or immigration volunteers, could read and consider responding to the Care Quality Commission (CQC) somewhat ‘informal’ consultation [p14] underway, on the approach to the CQC regulation in England?

This will affect how healthcare is regulated in IRCs. The closing date in March is unconfirmed.  Views are being taken now, in consultation via email: cqcinspectionchangeshj @ cqc.org.uk [1].

Joint working may be a good thing if it brings action to improve the health, care and welfare of the people in these institutions.

What it must not mean, is less frequent, independent, or less comprehensive reports by the HMIP which covers a wider area of inspection than CQC might.

Pregnant women, women who have been trafficked, torture victims: [added March 2: see Channel 4 on #Yarlswood] people are not getting the specialist support or care they should. Their carers and NHS staff are not universally getting specialist training they need.

Public pressure and transparency should support the campaign organisations who are familiar with these issues and demand change through MPs. There are big questions for IRCs whether people should be there at all, pregnant women and children even more so.

But specifically on health and welfare issues I would like to ask:

• MPs: if they are aware already, of The Tavistock Institute Report [2],  government response, and ask for action, not only in IRCs but across all detention settings (incl. indefinite detention)
• Ask: ‘is the parity of mental health delayed yet again, for people in prison and anyone in IRCs’? [ref the NHS Guidance to Mental Health Access  and Standards for 2015/16 from 12th February]
• Ask: ‘What will the NHS England awarded multi-million contract for healthcare at a number of detention centres to G4S and separately in prisons mean for standards and continuity of their NHS care?’
• Ask: ‘What training does NHS England offer healthcare staff who work with these people and how is it universally applied?’
• Ask: ‘How is the provision of quality medical care being assessed and well documented changes needed actually acted upon’?
• Ask: why are reports [as outlined in a letter from John Vine CBE QPM] taking so long to action? “The majority of my reports since January 2014 have been subject to significant delays between submission to the Home Secretary and being laid in parliament”
• Ask: ‘Why is it deemed NOT in the public interest to ensure that all the providers’ procedures, protocols, the expected standards they operate to, and clear accountability for when they do not,  are transparent and in the public domain?’

The state may have, in places, outsourced the service, but it cannot outsource its responsibilities.

In my research to date, the question that I am left with overwhelmingly is this:

“As a provider of punitive systems, can healthcare and welfare can be delivered “with an equal sense of fairness” through the same outsourced service?”

Are the steps Theresa May refers to in the recently announced Shaw review, an indicator of real change?

The reports and reviews over the last ten years listed above seem to have made no difference to the unknown man, who set fire to his stuff, on the Saturday evening of January 31st 2015 at Brook House.

Parliament is well aware of many failings already. [9] and there are known others which are yet to be made public. [10]

Since 2010 through June 2013 the HMIP reports clearly identify issues but what follow though is made and who is accountable for it?

While there are solutions needed to big philosophical questions that may trouble our conscience, like ‘what kind of country do we want to be to unaccompanied children escaping life threatening situations?’ equally big political questions continue to challenge: ‘How and why do we continue to engage multinationals with unanswered ethical questions on financial and humanitarian practices?’ ‘What hope for refugees and asylum seekers in Greece and what are the wider EU implications, if EU political and economic next steps are unclear?’

For now, for many people who want to take action, it is the small and practical which can be done, in practice. Often small acts which make a difference in the silent and unreported space between desperation and hope, for each person,  each day.  Supporting our NHS staff to ensure they get the specialist situation training they want and continue their invaluable roles in these places. Supporting the visitors’ volunteer groups. You might consider joining them.

Call on our MPs to demand change now, not review after review.

More reviews, reports, consultations and new legislation bills, seem to run in parallel with little, at least little public regard to one another and ignoring the continuity of their calls for change.

They could make a difference with cohesion between the responses and if accountable action were taken.

That needs compunction and oversight of accountable follow up.

Until however long the next review takes to report, and any action is put in place, we might see another fire, for another person; in another prison, or another young offender institution, or another detention centre.

It might be in one near you. It might affect someone you love. It may be a child.

It’s not over dramatic to say: it might be a matter of life or death.

****

If you are interested in more detail, read on below after the continue reading break:

A. What happens to someone at an IRC after a fire like this?
B. Review of Welfare & Mental Health at IRCs incl. detention time
C. Brook House, Gatwick Cluster
D. Who is responsible for the healthcare offered at IRCs? The role of NHS England and the CQC
E. Questions on Staffing and use of Force in care
F. Another Review, another Report? Will there be Change?
Conclusion: Burning questions on Immigration Removal Centre healthcare

References

A. What happens to someone at an IRC after a fire like this?

The G4S media spokesman said last week in connection with the fire, he was unaware of any standard health assessment or any procedures for the care of men after these incidents.

In 2010, only one year after opening, the HM Chief Inspector of Prisons report based on an announced visit at Brook House Immigration Removal Centre [3] had similar concerns and labelled the Brook House IRC as fundamentally ‘an unsafe place’.

If the inspectorate found in 2010 and again in 2013 that the mental health failings were serious, should it not be realistic to expect standard practices should already have been put in place since, for their improvement?

It had found that some patient medical reports indicated continued detention  was harmful.  Reports that acknowledged this were dismissed.

Clearly there is secondary mental health care, but how mental health support is given in the first instance is inconsistent.

In June 2013, the HMIP independent report [4]  also said:

“transfers to secure mental health units had been prompt. All custody officers attended a rolling programme of mental health awareness training, but there were no professional counsellors.”

The Tavistock report, given to the Home Office in January 2014 but published in Feb 2015, addresses this in detail and echoes the same: “Psychological talking therapies are scarce in the IRCs.”

B. Review of Welfare & Mental Health at IRCs – especially regards indefinite and long term detention

On February 9, the Home Secretary announced an independent review [5] of policies and procedures affecting the welfare of those held in immigration removal centres. (IRCs)

The Tavistock report into mental health was simultaneously released to the public, a year after it was given to the Home Office.

That the Home Office was criticised for delaying the report’s release may do little to improve what the report identified as:

“mistrust at all levels of those involved, whether campaigning organisations or policy developers, between those advising/representing detainees and immigration caseworkers/detention staff.”

This lack of trust is identified as harmful, leading to missed opportunities to improve how mental health issues are dealt with.

Findings in the report include that the mental health issues of detainees is often directly linked to uncertainty over what is happening to them in relation to possible return or removal. Therefore shorter ‘processing’ / detention times are recommended:

“The Home Office’s and IRCs’ culture of ‘detention’ should be shifted towards a culture of ‘temporary transitional institution’ with the primary task of aiding, helping and preparing detainees to be returned to their countries of origin. This would be a culture-changing initiative.”

In particular the Inspectorate worried that the centre, designed to hold people for just a few days, was not suitable to hold detainees for extended periods of months and even years.

However today, three years later, many men are still there an awfully long time.

The reasons for detention can be as varied as they are complex.

Failed asylum appeals. Flawed asylum appeals which should have been taken care of on their arrival as children, often without family or birth paperwork, may mean deportation as adults. Expired visas, as well as a minority with expired rights to stay and criminal convictions.

It would be naive to think that there are easy solutions because every case is unique.

But in a setting designed for short term, one man in 2013 has been imprisoned in Brook House for over three years. He had been living for 14 years in England, having come to England aged 9. Now at 23 he was effectively to be returned to a ‘foreign’ land.

Clearly being left in limbo is unsettling, and in the wrong care, harmful. But what common sense assessment results in this?

New plans seek faster processing, and rightly address the issues created by this long term uncertainty. What will the side effects be?

Is the goal only to deport faster and make timed targets the goal?

If so, might the way in which each case for each person is reviewed on an individual basis given less importance?

Already, women at Yarl’s Wood are reported to be getting generic information, regardless whether they are a detained fast-track case, a detainee who had arrived by lorry or one who had been refused entry.

Is the goal to make things better for the individual, or for the Home Office and administration in its outsourced providers?

How can any change aimed at reducing indefinite detention future-proof thorough and proper processing procedures?

C. Brook House

Brook House opened in March 2009, managed by G4S, and has the capacity to hold 426 men in a similar style of security as a Category B prison, next to Tinsley House, a similar 136 bed detention centre.

The concrete block is sandwiched between the south perimeter road, immediately facing onto the Gatwick runway, and  a parallel road behind, among much barbed wire and very high fencing.

Bleak House may have had a more pleasing prospect.

The independent HM Inspectorate of prisons carried out an unannounced inspection at Brook House in June 2013 and released a wide ranging report on the site, staff and men under their care.

In the report [4] inspectors were concerned to find that there was a considerable frustration among detainees which was reflected in high levels of self harm.

“At the time of our inspection , three detainees were refusing food and they were being appropriately cared for in their normal location.” [2013 report] [4]

Report after report by the HMIP confirm issues since its first review there in 2010, including long waits for legal advice and a higher level of long-term detention than at 136 bed  Tinsley House nearby.

At Brook House, an overwhelmed onsite Home Office contact management team meant detainees were unable to get information or help with their cases.

Despite having understanding for their complexity, there are clearly procedures and processes which fail these men, and women and children elsewhere.

These failings are not new and clearly known by the Home Office,  yet not to have been acted upon in three years.

Who decides that these are the kinds of people and companies to represent the state in our public services? [The Guardian, 22 December 2014]

D. Who is responsible for the healthcare offered at IRCs?

In between the publication of these reports, in Summer 2014, the commissioning was taken over by NHS England (the Commissioning body) which directly awarded G4S the multi-million contract for healthcare at a number of detention centres. [6]

G4S had been also responsible for much of it in practice previously, but this changed how it was procured, and in some new, additional locations. It appears to be for £95M over 7 years.

There is little documentation in the public domain on this, and how the exact process works, but Corporate Watch gave their opinion here.

Keep Our NHS Public wrote: “The contract was never advertised on the OJEU. It was advertised on Supply2Health – which is for health contractors / commissioners, not the public.”

The contract ‘award’ was published and says:

The healthcare services will include but not be limited to: Primary Care GP and Nursing services, Healthcare Administration, Mental Heath Services (primary care and where needed some secondary care), Sexual Health Services, Clinical Substance Misuse Services, Allied Healthcare Services (e.g. Chiropody/Podiatry, Physiotherapy etc), Optometry Services, Pharmaceutical Services, Dental Services, Clinical Waste management, Radiology Services (including radiographers, radiation protection advisor/s – where X-Rays are in place), Health Promotion, Continuity of Care .

The above list is not exhaustive and full details on the required services were outlined in the service specification as part of the contract documents for those Bidders invited to tender.

Scrutiny of its health and social care is now the responsibility of the CQC, which has to date not inspected Brook House. [one of three sites in the so-called grouping ‘Gatwick Cluster’.]

CQC visited the Cedars in January 2014 [the Sussex sister site for families], when there were no detainees in residence.

The CQC has oversight for regulation, and inspection of the health and social care in the IRCs but are yet to visit them.

“We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often.”

There are some who criticise inspection. Clearly inspection of these institutions is necessary, the HMIP report shows transparency is so important, but surely you need to meet the people who live there?

Whilst it has not yet done an inspection of the majority of IRCs, it is currently consulting on their CQC delivery process.

The Care Quality Commission (CQC) has an unofficial consultation underway, on the approach to their regulation.  Views are being taken now, in consultation via email: cqcinspectionchangeshj @ cqc.org.uk  The closing date in March is unconfirmed.

In a further publication, in October, the ‘Achieving Better Access by 2020’ touches on p.11 on the criminal justice system and on people with mental health problems who end up in police cells after detention under section 136 of the Mental Health Act.  [Increased transparency on this issue would surely help.]

However, the Guidance to Access and Standards [11] for 2015/16 on 12th February [10], seems to have forgotten them completely. It may be provided to Local Authorities and NHS Commissioners, but many in the IRCs are being managed only on site by non-NHS staff.

The IRCs’ support isn’t mentioned at all in either document.

The HMIP 2013 report which included wide ranging notes on welfare, overall gave Brook House a reasonable 2013 report and inspectors had ‘observed sustained improvements’.

But each and every one has major findings of basic failing care, some better than others.

Haslar, state run, is one of the smaller and best according to their last HMIP report, but even there ” the range of mental health services was not adequate to meet detainees’ needs” and recommendations include the simple: “All detainees should undergo a routine health screening on arrival.”

Colnbrook at Heathrow, receives both similar praise and criticism, including common issues on night transfers and criticism in mental and physical healthcare.

Yarl’s Wood, has additional concerns because it holds women and children. One person has been there over 4 years. Children have been held illegally. Some have been trafficked but lack support services. In one case, a detainee without leave to remain had been picked up working in a brothel but no referral had been made. Some women are pregnant and it is unclear why they have been detained at all: (p5)

“Several obviously mentally ill women had been detained before being sectioned and released to a more appropriate medical facility; it was difficult to understand why they had been detained in the first place. Pregnant women had been detained without evidence of the exceptional circumstances required to justify this.”

Pregnant women are not provided maternity clothes as standard practice which would be a decent, practical thing to do.

Volunteers train with charities and visit these people without causing a national furore because they need access to get people helped, filling in the vast gap between desperation and hope.

If given leave to speak freely without fear of side effects for the people they help and the access they need, if they turned to whistleblowing as is going to be built-by-design in other parts of NHS care, I believe would reveal an embarrassing lack of humanity.

Basic essentials like soap, seem scarce.

There is clearly a huge amount of work, very good work, done by caring and professional NHS and other staff at these sites.

Reports do raise both good and bad. But a common feature is lack of specialist training, for either primary care staff or on site staff to deal with the complexity of care people need who are victims of trafficking, torture or abuse. These are not regular clinic patients.

Nick Hardwick, HM Chief Inspector of Prisons, summed up in January 2015, in a report on Campsfield operated by Mite in Oxfordshire:

“whatever the strengths of the centre, detention should not be used for children, victims of torture or anyone for unreasonable lengths of time.”

Beyond these independent reports, information is hard to get hold of for these institutions directly or transparently.

Freedom of Information can’t ask the private firm direct  questions, and only some are answered indirectly via the Home Office.

Why is it deemed NOT in the public interest to ensure that the expected standards they operate to, and accountability of when they do not, are transparent and in the public domain?

It is our government’s choice how these people are detained, administered and looked after.

How will current reviews change that, and what other legislation could threaten to put greater regards to profit in their regulation?

What happens if the commercial, for profit companies, want more?

E. Questions on the Staffing and use of Force in care

It is unlikely that government will want to pay more than already planned, so if a company wants to make more profit, they will need to cut their costs of providing the service.

One major cost is staff, which has already seen big changes in both the public and private sector prisons.

The “appropriate” use of force by G4S staff has been scrutinised in recent years by some media, resulting in criticism of techniques employed and of a lack of accountability when things go wrong.

When things go badly wrong, people die.

After the death of Jimmy Mubenga during his removal on a plane at Heathrow in 2010 it took until December to see the guards on trial.

“In doing so, they held Mubenga bent forward so that his ability to breathe properly was inevitably impaired.”

“‘I can’t breathe’ shouts were heard by many a passenger seated further away.” [reported witness accounts]

The G4S guards were acquitted. The inquest a year earlier had found Mubenga was unlawfully killed. [BBC, July 2013]

So the question remains open, by whom?

The question also remains unanswered why do deaths under restraint in custody happen repeatedly and what is really being done to avoid them?

In April 2004 Gareth Myatt, a 15 year old boy, died in Rainsbrook Secure Training Centre.

On 9 August 2004, “Adam Rickwood, aged 14, committed suicide at Hassockfield secure training centre.

The jury at the inquest in to Adam’s death found that a restraint incident some hours before Adam’s death had not contributed to it and that staff at Hassockfield had behaved appropriately throughout the time he was at the centre – but it was a clearly a distressing incident for Adam.” [The government’s response to coroners’ recommendations]

Ten years on, it is reported that restraint techniques used since have changed, but the public is not allowed to know how exactly.

“The Ministry of Justice refused my freedom of information request for the MMPR manual because officials fear inmates will study the document in their cells and develop countermeasures.”  [Carolyne Willow, Guardian April 2014]

Members of the Refugee Children’s Consortium have continually raised concerns about the use of force on children, especially during deportation. [February 2014, in Immigration Bill debate]

Bail for Immigration Detainees reported that a “child was dragged along the ground at the airport by removal escorts as they attempted to forcibly remove the family from the UK.”

Complaints of excessive force made by immigration detainees were documented comprehensively in 2008 in the Outsourcing abuse dossier which covered excessive use of force over several years.

That resulted in a review and report by Baroness Nuala O’Loan released in 2010 under the current Home Office’s watch, seven months before Jimmy Mubenga’s death.

What lessons have been learned since Jimmy Mubenga’s death in 2010?

Force used at Brook House, three years later [2013 HMIP report]:

“Force had been used 61 times in the previous six months, slightly higher than in 2012 but lower than similar centres. About 60% of the incidents involved the use of restraint locks or pain compliance techniques. Many incidents occurred when detainees refused to be removed for overseas escorts.” [2013 report]

Six months after of the death of Mike Brown in Ferguson, and after the world watched the death of Eric Garner on amateur video and heard his last words; I can’t breathe, those three words have been now adopted by a global hashtag. Black Lives Matter #BLM.

Jimmy Mubenga said I can’t breathe in London on October 12 2010.
And died.
Eric Garner said I can’t breathe in New York on July 17 2014.
And died.
Others in both countries have over the last ten years, been held in custody or restrained directly or indirectly.
And died.

Many see a united cause and this group were recently on the street at Victoria in London, protesting about G4S and #BLM.

Patrisse Cullors, Black Lives Matter said: “Some of the differences are the technical differences around the apparatus of law enforcement accountability, but the same thing is dealt to victims of police and state violence – which is no accountability.”

That these same words were the last of men who died as a result of techniques used to hold them, should be red flags for change.

These red flags are not new. But why are they being ignored?

Lord David Ramsbotham GCB CBE, Her Majesty’s Chief Inspector of Prisons – December 1995 – August 2001 wrote the foreword in the 2008 report [7]  in which he identified:

“a most unfortunate attitude, adopted by officials towards issues surrounding asylum and immigration, described by the Commission as ‘a culture of disbelief’.”

It seems this culture of disbelief is allowed to continue.

The IAP on Deaths in Custody has produced a comprehensive statistical breakdown of all recorded deaths in state custody between 1 January 2000 and 31 December 2010.

The report found that deaths of people detained under the Mental Health Act (MHA) and those in prison custody account for 92% (5,511) of all deaths in state custody.

The February 2015 Home Office response by today’s government only accepts in part that some of the issues raised and recommendations in the Tavistock Institute Review.[8]

In the meantime, the detainees are protesting via the few channels they have.  Self harm, starvation and setting things alight.

F. Another Review, another Report? Will there be Change?

In the IRC consultation at the CQC it says:

“In the past it has been a challenge to get a clear picture of the services that are provided in prisons, young offender institutions and immigration removal centres.”

As these reports all paint the picture is clear. The challenge is to see accountable action.

The Home Office is yet again reviewing IRC care in an independent review, headed by Stephen Shaw [6], of the welfare of immigrants held in detention centres or set for escort, including prior to deportation.

“Shaw will have to look at the extent to which the Home Office complies with its own rules designed to protect “any detained person whose health is likely to be injuriously affected by continued detention.”

Much of what it should find, is already clear to many people familiar with the IRCs and the men, women and children in their care.

Theresa May in the Home Office announcement of the Shaw review said: “We are building an immigration system that is fair to British nationals and legitimate migrants, but we must also ensure it treats those we are removing from the UK with an equal sense of fairness.”

In my research to date, the question that I am left with overwhelmingly is this: as a provider of punitive systems, can healthcare and welfare can be delivered “with an equal sense of fairness” through the same outsourced service?

The state may have outsourced the service, but it cannot outsource its responsibilities.

Is the building Theresa May refers to, an indicator of real change?

The reports and reviews over the last ten years listed above seem to have made no difference to the unknown man, who set fire to his stuff, on the Saturday evening of January 31st 2015 at Brook House.

Parliament is well aware of many failings already. [9] and there are known others which are yet to be made public. [10]

Since 2010 through June 2013 the HMIP reports clearly identify issues but what follow though is made and who is accountable for it?

Health and social care failings were raised in each year’s report.

Health and social care failings were also raised in the Tavistock Report which made both criticisms and recommendations.

Despite this, the Home Office does not accept all the findings. [8]

Conclusion: Burning questions on Immigration Removal Centre healthcare

If the Home Office and others cannot accept all the findings of  comprehensive and independent reports, and continues this “culture of disbelief” how will change happen?

Since both those inspections/ reports were carried out, new contracts and more money have been given by NHS England to G4S, the same provider as before in many places – a 7 year contract- was that decision made with any regard to the failings in reports from inspections which had been made over the past 3 years?

If so, with what transparent process of follow through for improvements and any accountability for delivery?

How long will yet another report take and will it result in anyone held accountable for deaths, for healthcare and for fixing the clearly damaged and damaging systems of mental health care and welfare?

How will the CQC consultation benefit the care received by the men, women and children held in detention and will it create accountability and improve standards?

How long the latest Home Office review takes and if the outcomes are accepted, will determine if it can make a difference.

Like the lack of trust identified as harmful in the Tavistock Institute report, lack of transparency will surely result in missed opportunities.

Firstly, to understand the full picture of problems which need resolved and then to to share best practices between these providers and the organisations responsible for their oversight.

References:

[1] CQC on regulation of IRCs

[2] The Tavistock Institute Review into Mental Health in IRCs

[3] HMIP Brook House Immigration Removal Centre Independent Report from May-June 2013

[4] HMIP Brook House Immigration Removal Centre Independent Report from March 2010

[5] Independent Shaw Review announcement

[6] Tender to outsource immigration removal centre healthcare United Kingdom-London: Health and social work services 2014/S 119-212368 Contract award notice Directive 2004/18/EC

[7] Outsourcing abuse: The use and misuse of state-sanctioned force during the detention and removal of asylum seekers (2008).

[8] Home Office Government Response to the Tavistock Institute Review

[9] Home Affairs – Minutes of Evidence June 2013

[10] Letter from John Vine CBE QPM  “The majority of my reports since January 2014 have been subject to significant delays between submission to the Home Secretary and being laid in parliament[2].  I consider that lengthy delays in publishing reports risk reducing the effectiveness of independent inspection, which depends to a large extent on timely publication of findings, and it is contributing to a sense that the independence of my role is being compromised.”

[11] NHS England Guidance to Access and Standards on Mental Health for 2015/16 published on 12th February 2015

Stats: How many people are we talking about?

“There are 119 prisons in the UK, with a total detained population of 85,385 adults (September 2014). Just 5% of detainees are women.InadditiontherearesixYOIs that hold juvenile offenders aged under 18.

“In 2013, the Ministry of Justice reported that 49% of female and 23% of male prisoners were assessed as suffering from anxiety and depression, compared with 19% of women and 12% of men in the general UK population.

“IRCs hold asylum seekers on their arrival to the UK while they are waiting for a decision on their case or waiting to be deported. There are 12 IRCs in the UK holding a total of 3,079 people (June 2014).” [CQC, Inspecting Together 2015]