We have received a request under the Freedom of Information Act 2000 for the following information for the Immigration Removal Centres at (i) Harmondsworth, (ii) Colnbrook, (iii) Dover and (iv) Brook House:
1. What procedures are in place for detainees to access medical care within the IRC? Are there any forms to complete or do detainees simply attend the healthcare unit to be seen by a professional? Are appointments made or are clients seen on a first-come, first-served basis? Are the procedures the same to see (i) a nurse; (ii) a general practitioner; and (iii) a psychiatrist?
2. If a detainee requires regular medication, what system(s) are in place for the regular dispensing of these medicines? What system(s) are in place for repeat prescriptions? Are detainees or healthcare staff responsible for requesting repeat prescriptions?
3. What mechanisms, if any, are in place to assist any detainees who have difficulty remembering to take their medication regularly?
4. a) In the period 1 August - 31 October 2010, how many requests were made for detainees in each IRC to have an appointment with a psychiatrist?
b) Of these requests, how many were made by staff and how many were made by detainees themselves?
c) In the period 1 August - 31 October 2010, on how many days was a psychiatrist available for appointments at each centre? For how many hours was a psychiatrist available at the centre on each occasion? If this information is not available, for how many hours was a psychiatrist in attendance at each centre during the period 1 August 2010 - 31 October 2010?
d) How many detainees attended appointments with a visiting psychiatrist in each IRC in the period 1 August 2010 - 31 October 2010?
5 a) For all detainees seen by a psychiatrist in the period 1 August - 31 October 2010, what was the average waiting time between a request for an appointment with a psychiatrist being made and attending an appointment with a psychiatrist?
b) If no average waiting time figure is available, what was the longest and shortest waiting time for an appointment?
6. What is the centre’s policy regarding access to healthcare for detainees who become aggressive to healthcare staff? Does the policy distinguish between those who are aggressive because of mental health problems and those who are aggressive for other reasons?
We released the following information on 7th December 2010:
Responses to each question from the four centres are listed below.
Brook House IRC
- Nurse - patients have an open access to see the nurse, they attend during set times. Patients wait to be seen in turn, but the waits are not long, and all who arrive are seen.
Doctor - The nurse will triage patients for the doctor and offer appointment times that the individual return to. Individuals do not need to discuss with the nurse why they wish to see the doctor, but they do need an appointment for logistical reasons.
On arrival in an Immigration Removal Centre, all detainees are offered an appointment to see the GP. Psychiatry - Access to psychiatrists is by referral to secondary care providers as commissioned by NHS West Sussex. Such referrals are made by the clinic team in line with the procedures set out by the commissioners.
- Individuals who require medication will have been assessed as to their suitability to have medication in possession or needing unit doses to be issued. This is based on a time tested process adopted in most IRC and HMP establishments. Those who have been assessed as appropriate to be holding medication in possession, they will be given 14 days supply (typical) and their use monitored at review/ repeat date when their need for supplies is logged
- Individuals who are assessed as needing support for whatever reason, collect their medication on a dose by dose basis. Individuals who have their medication in possession and are subsequently identified as being non compliant, will convert to daily dosing. Each dose that is due to be administered is identified before medication times, by their computer records, and if an individual fails to attend they are contacted to discuss the importance of compliance. Occasionally individuals are collected by officers for each dose.
4 a) Five referrals were made to the psychiatry service within October. We are unable to verify what referrals were made in August and September.
b) As detailed above, individuals do not have an open access to psychiatrists.
c) Brook House does not have a regular psychiatric attendance. The psychiatrist attends on an occasional circumstances, but ordinarily expects an individual to go the Hospital’s out patient clinic.
d) How many detainees attended appointments with a visiting psychiatrist in each IRC in the period 1 August 2010 - 31 October2010?
The NHS provider is changing the way in which it provides its care, bringing it in line with NHS standards. As a result of this a psychiatrist rarely attends the centre, as above, and individuals who need care are required to attend the Hospital. This activity is not monitored by Brook House on a speciality basis - merely recording the number of individuals attending hospital appointments.
5 a) This information is not monitored by healthcare.
b) The waiting time is determined by the NHS providers and is not recorded by us.
6. The centre does not tolerate aggressive behaviour to staff for any reason, and where individuals become aggressive, Detainee Custody Officers offer appropriate support.
- Detainees have 24 hour access to healthcare staff through various channels. 1) During medication rounds on each wing 2) Triage clinics at the end of each medication round 3) Medical application process. Detainees complete and submit application forms stating which clinician they require a review with. These are collected twice daily by the healthcare administrator or nursing staff on each wing. On receipt, each application is logged on a database and allocated to the required clinic by the healthcare administrator. To ensure that we strive to reduce waiting times for the GP clinic, detainees will attend a nurse triage appointment in the first instance and the nurse will attempt to address any minor issues whilst referring on to the GP clinic for those more urgent or complex cases. 4) Wing staff will also contact the healthcare department and raise concerns about those in their care if required. Every attempt would be made by the healthcare team, to ensure that a nurse attends this residential area at the ffirst available opportunity, to speak with the detainee in question and attempt to resolve or address any ongoing or outstanding issues.
Detainees, who request a review with the psychiatrist, will first be assessed and triaged by an RMN (registered mental nurse) to ensure that the referral is appropriate. Should there be concerns re mental illness, the detainee would be booked into the next available psychiatrist clinic.
- There are 4 medication rounds within the centre each day, morning, lunch, tea time and night time. Nursing staff attend the secure treatment rooms outside each residential area and dispense under the supervision of DCOs (Detainee Custody Officers). Pharmacy assistants liaise with the healthcare administrator to ensure that GP review appointments are scheduled prior to the end date of each prescription. Repeat prescriptions are not dispensed unless the medication is re-prescribed by the GP at time of review. This is the same process for both supervised and in-possession prescriptions.
- There is a robust in-possession medication policy in place within the department. At time of review and prescribing, the GP must complete a risk assessment for those detainees whom he/she may consider appropriate for in-possession medication. The GP would not prescribe in-possession medication for those who are unable to self medicate safely and appropriately. Those detainees, who do not meet these criteria, would have their medication dispensed daily, at specified intervals, by nursing staff. Nursing staff will ensure that those prescribed supervised medication, always attend for their treatment at the required times. 4. a) During this period, 154 appointments were made; this included those self referred and triaged by the RMNs, those referred by the GP and those referred by the counsellors.
b) During this period 98 detainees attended the psychiatrist clinic. 56 detainees also attended the psychiatrists’ substance misuse review clinic.
c) The psychiatrist attends the department twice a week for a total of 12 hours. He currently provides one full day and one half day session each week. There have been no breaks in service between 1st August 2010 - 31st October 2010.
d) During this period there was one appointment with a visiting psychiatrist.
5 a) Detainees are triaged on the same day as the referral is received in the department by an RMN. If a further referral is required to the psychiatrist clinic, then there may be up to a 5 - 7 day waiting period.
b) As above.
- There is a zero tolerance policy in operation within the department. Detainees who become hostile or abusive will be offered the opportunity for a further appointment under close supervision of DCOs. Due to the risk of harm to self or others, and where mental health issues may be present, it may be appropriate for the GP to prescribe medication which will reduce agitation and enable staff to complete a full assessment without the detainee becoming hostile or agitated.
- An appointment system is not in place at Dover IRC but nurses will go to the residential houses to deal with emergencies, or we see the detainees in healthcare who are taken ill. Detainees will be assessed by a nurse before being referred to the GP where necessary. All centre staff can contact healthcare regarding any mental health issues and the detainee will be seen by a mental health nurse or the in-reach team who will refer to a psychiatrist if necessary.
- Detainees are informed that they are responsible for requesting repeat prescriptions and the Centre also carries out reviews of medication, they are passed to the GP to either do a repeat prescription or to see the detainee to explain what the situation is regarding their medication.
- Where a problem has been identified the detainee is placed on supervised medication and required to attend Healthcare daily. Should they fail to attend then they are contacted.
4 a) There were 10 requests during this period.
b) All were made by staff.
c) The psychiatrist was at the centre for 13 days during this period.
d) Ten detainees were seen by the in-reach psychiatrist.
5 a) The longest waiting time was been a week.
b) As above.
- The Centre does not have a policy in place but aggressive behaviour to staff for any reason is not tolerated.
1.Nurse appointments are made as and when requested by the detainee himself.
a) GP appointments are made either directly by the detainee via a nurse and or through a triage consultation.
b) Psychiatrist appointments are usually made through a referral by the GP to Registered Mental Health Nurse (RMN), after RMN’s consultation, if he/she deem it necessary then an appointment for the psychiatrist will be made.
2. GP/Psychiatrist would create a prescription if necessary and the length of the prescription.
a) Prescription charts are kept in the pharmacy ready for dispensing at the appropriate times. Times are displayed through out the centre and detainees are made aware of the frequency they need to attend healthcare to take their medication. Some medication is given to detainee himself (in possession) for the length of the treatment.
b) If an illness is known to be long term, healthcare staff can usually ask for repeat prescription, but in most cases we always feel it is good practice for the detainee to be seen by the GP, this is to see the progress of the treatment and also to make sure there are other concerns rising.
3. Reminders are sent via text message to mobile phones and unit staff are made aware.
4 a) 23 appointments made only 19 attended due to detainees leaving the centre.
b) All appointments made by staff
c) Psychiatrist available for 4 hours for each surgery (fortnightly)
d) 23 detainees
5 a) & 5bTwo weeks in all cases (maximum)
6. Healthcare does not have a specific policy on this subject; however aggressive or abusive behaviour towards staff is not tolerated under any circumstances.
If and when it becomes apparent that the behaviour is due to mental health problems, then healthcare will provide appropriate support to the security department at all times; regular GP/Psych visits, medication is taken by detainee on regular and appropriate times.