By Liz Peretz, Campaign to Close Campsfield
Trigger warning: self-harm, suicide

People held in immigration detention centres are among the most vulnerable people in our society. Many detainees have suffered torture or ill treatment, have significant and chronic health problems, or have been detained for prolonged periods of time without any prospect of removal. Furthermore, they are powerless and may fear that if they make a complaint there will be repercussions.
It is now widely accepted that detention itself damages health, and causes mental ill-health, which gets worse the longer a detainee is held.

A legal requirement to provide healthcare

While detention centres like Campsfield ‘House’ continue to exist, people locked up in them are entitled under law, secondary legislation and guidance to healthcare which should be of the same standard as that enjoyed by the rest of the population in the UK, and which should take account of their special needs.
Broadly speaking, our government is required by law to keep out of detention people who have been tortured, or are pregnant, or are in other ways particularly vulnerable.*  The government is required to seek the advice and assessment of medical practitioners and to follow it.  The government is still supposed to act on the principle of a presumption of liberty in all cases (which arguably it clearly does not). If, however, a person is locked up, then our government has a duty of care towards him or her – and that includes medical assessment, treatment, and continuity of care.  According to the government’s own inquiry, the Shaw Review, as well as a number of reports by other organisations such as Medical Justice, health care needs to improve, especially as all immigration detainees are particularly vulnerable group and many have high mental and physical health needs.

A history of problems in healthcare at Campsfield

Yet ever since Campsfield was opened, 23 years ago this month, there have been reports of healthcare shortcomings or failures.
Bill MacKeith of the Campaign to Close Campsfield says:

“Problems reported to us have included:

  • poor care (detainees used to call the doctor ‘Dr Paracetamol’ because that was the extent of prescription on offer)
  • lack of confidentiality (consultations not held in private)
  • lack of access to prescribed hospital treatment
  • withholding medicine for chronic conditions such as diabetes, HIV or pain (‘you can come and get it from the health centre when you need it – no you can’t have a supply to keep’)
  • lack of continuity of care (for example, medical notes not following an individual, and not being sent on when they are moved). If the medical notes are not available, this means that treatment may in effect be denied.

Two young men have taken their own life while imprisoned in Campfield, an indictment of the health ‘care’ in itself: on 27 June 2005, Ramazan Kimluca, 18, a Kurdish asylum seeker, hanged himself, and on 2 August 2011 Ianos Dragutan, 31, from Moldova, hanged himself in a shower at Campsfield.
On 18 October 2013, Farid Pardiaz, who according to a psychiatric report was expressing a depressive episode at the time, set fire to B Block in Campsfield. His requests to see a doctor in the days leading up to his desperate act were refused.”

There should be a fail-safe method of keeping out of detention people who fall into the ‘vulnerable’ groups proscribed under law and guidance. However, a Campsfield, the necessary assessment by a medical practitioner rarely takes place. Even when a medical practitioner makes a clear assessment that a person should be released, and forwards this to the Home Office, the responsible Home Office Immigration Enforcement case worker rarely accepts it. This is especially true for torture victims.

Responsibility passes to the National Health Service

In 2012, visitors and campaigners heard that healthcare was going to be the responsibility of NHS England, not the Home Office, and that existing contracts between individual detention centres and private healthcare providers would be phased out. Visitors and campaigners hoped that, finally, the responsibilities laid out in law and guidance might be honoured a little better.  Campsfield’s due date for the change was 2015.  There has been no improvement.  What has happened since then is almost certainly worse than what happened before.  Negligent practices have continued. Those responsible, NHS England, the commissioners, are also responsible for offender health and do not seem to appreciate that people held in Campsfield are not criminals, but people held for the administrative convenience of the Home Office. Detainees are routinely handcuffed when taken for medical appointments.
Campsfield has a ‘stakeholders’ meeting twice a year, convened by MITIE which runs the centre, to which several voluntary organisations are invited.  Healthcare has been a standing item of complaint. Sometimes, only, a representative of NHS England attends, but the same representative has refused to meet local representatives and advocates separately.

A labyrinthine system

An ad hoc national group of campaigners and visitors is now inquiring into health care in detention centres. What they are finding is a labyrinthine system, with partnership agreements between government departments which lead to local or regional contracts with private health providers in many cases.  In Campsfield the private health care provider is Care UK.  This is part of Bridgepoint Capital, a company interested in making a profit and paying as little tax as it can.
At Campsfield, Care UK holds a five-year contract with the NHS England southern regional office.  This contract is based on a ‘baseline assessment of need’ in the detainee population carried out in 2014 by a private consultancy called Community Innovations Enterprise (CIE) and authored by Dr Jon Bashford, Sherife Hasan and Professor Lord Patel of Bradford with NHS England. The ‘baseline assessment’ forms the basis of guidelines and key performance indicators (KPIs) on which Care UK has to report to a named officer in NHS England South.
This may all sound a long way from detainees’ health and wellbeing.  But unless campaigners engage with this tangle of bureaucracy and hold the ‘commissioners’ (NHS England, Public Health England, Home Office Immigration and Enforcement) and ‘providers’ (such as Care UK) to account, things won’t improve. All parties will hide behind ‘contracts’ and ‘agreements’.

The commercial contracts fail to address major health issues

The base line assessment of detainee needs for healthcare, the summary contract, and the KPIs of that contract are all far from what any detainee or any visitor would say were the main health needs of people in detention centres. There are indicators for obesity, learning difficulties, alcohol and drug cessation, but no timescale for getting torture victims or other vulnerable people swiftly medically assessed and given back their liberty; no performance indicator on access to existing medicine; on swift treatment when needed outside the detention centre, on not handcuffing detainees being taken to outside appointments; nothing about the medical records that often go missing, or on continuity of care; no reassessment requirement (even though it is widely accepted that continued detention is very bad for people’s mental health).
And – also worrying – there do not appear to be clear procedures in place at Campsfield for MITIE management to cooperate with Care UK management. Yet at all points healthcare depends on such co-operation. For example, transport, escort, arrangements for hospital appointments, good provision of medication and handling of medical notes, handling the healthcare needs of people kept in ‘solitary’ – all require co-operation between the two contractors. Surely this should be a priority performance indicator for both MITIE and Care UK?

Holding authority to account

In June, NHS England and Care UK presented a report to the Joint Health Overview and Scrutiny Committee of Oxfordshire County Council, which has a duty to scrutinize health service provision in the county ).  This body is not known for criticising local health bodies when they make reports, but in this case the chair asked pointedly for ‘some data’ so her committee could see what was really going on. Three months later she was presented with data on suicides in prisons – and told ‘no other data is available’.  (Attempted suicides and self-harm in immigration detention centres are common and indeed reported on regularly by the Home Office.) We will continue to press for close scrutiny by the councillors charged with providing it in Oxfordshire, and hope others elsewhere in the country will press their local authorities in the same way.

* Groups listed as unsuitable for detention except in very exceptional circumstances are: unaccompanied minors; families with a minor under the age of 18; the elderly; pregnant women; those suffering from serious medical conditions ‘if their conditions cannot be satisfactorily managed within detention’; those suffering from serious mental illness ‘if their conditions cannot be satisfactorily managed within detention’; those with independent evidence of a history of torture; persons with serious disabilities; persons identified as victims of trafficking.

Experience of many organisations such as Medical Justice, BID, Red Cross, is that people in these categories are detained very frequently and their stories/conditions are denied.  Very exceptional circumstances are never defined and shrouded in a mystery of inconsistency.  Medical examinations (physical and mental) are often not made in appropriate way, by a qualified person, according to the ‘rules’, or even do not happen at all or too late.

The Campaign to Close Campsfield makes occasional posts on health care in detention.  See: https://closecampsfield.wordpress.com/healthcare-in-campsfield/