Guidance

Inpatient hospital admissions for people detained under immigration powers (accessible)

Published 8 June 2026

June 2026

Any enquiries regarding this publication should be sent to us at DSOConsultation@homeoffice.gov.uk

Document details

Process: This DSO sets out how contracted service providers, Healthcare providers, escorting staff and Home Office teams must communicate and coordinate when a detained individual is admitted to hospital, ensuring timely notifications, effective risk management and appropriate detention or release decisions throughout the admission.

This guidance does not apply to those detained in Residential holding rooms or directly managed short-term holding facilities.

Implementation Date: June 2026

Review Date: June 2028

Version: 1.0

Contains mandatory instructions

For Action: Home Office teams working in immigration removal centres (IRCs), residential short-term holding facilities (RSHTFs), and the pre-departure accommodation (PDA). Home Office case workers, contracted service providers (CSPs), escort providers and Healthcare teams.

For Information: N/A

Author and Unit: T. Gibbs, DS Healthcare and Safer Detention Lead

Owner: T. Gibbs, DS Healthcare and Safer Detention Lead

Contact Point: DSOConsultation@homeoffice.gov.uk.

Processes Affected: Hospital in-patient admissions for people in immigration detention.

Assumptions: All Home Office staff and CSPs/escort providers (including Healthcare providers) will have the necessary knowledge to follow these procedures.

Notes: N/A

Instruction

Introduction

1. Detained individuals may be admitted for in-patient treatment in hospital from IRCs, RSTHF, PDA or when under escort for a variety of reasons. It is important that where an individual is admitted to hospital, this is communicated to the Home Office without delay as this may impact the ability to effect an individual’s removal from the UK and consequently the appropriateness of their ongoing detention, how risk is managed (in hospital and/or on return to detention) and welfare considerations if released from detention.

2. This guidance also covers specific considerations relating to the management of detained individuals being admitted to hospital under the Mental Health Act 1983, Mental Health (Care and Treatment) (Scotland) Act 2003 (legislation.gov.uk) and The Mental Health (Northern Ireland) Order 1986 (legislation.gov.uk). References to “centre” in this document cover IRCs, RSTHFs and PDA.

3. Individuals detained under statutory immigration powers may be detained in any place of detention named in the Immigration (Places of Detention) Direction 2025. These settings include IRCs, prisons and hospitals.

4. When an individual is detained under statutory immigration powers in hospital, reviews of detention must continue to be conducted in accordance with the Detention General Instructions and the Adults at Risk policy. This includes when individuals are detained under the Mental Health Act 1983, or the Mental Health (Care and Treatment) Act 2003 in Scotland, following a transfer under section 48 (section 136 in Scotland). In Northern Ireland, the relevant legislation is the Mental Health (Northern Ireland) Order 1986, which governs compulsory admission and treatment for mental disorder. This framework is broadly equivalent to the Mental Health Act 1983 in England and the Mental Health (Care and Treatment) (Scotland) Act 2003.

5. Rule 9 of the Detention Centre Rules (DCR) 2001 The Detention Centre Rules 2001 sets out the statutory requirement for people to be provided with written reasons for detention at the time of their initial detention and thereafter monthly (in this context “monthly” means every 28 days). The written reasons for continued detention at the one-month point and beyond should be based on the outcome of the review of detention.

6. Rule 36(1) of the DCR 2001 sets out a requirement for the manager to notify the Secretary of State without delay of a serious illness, severe injury, or removal to hospital on account of mental disorder. The Operating Standards for IRCs (Security – Escorts) Detention services operating standards manual - GOV.UK requires a nominated manager from the centre to visit a detained individual in external hospitals once a day, with a requirement to record that the visit has taken place. The Operating Standards additionally set out the steps that should be undertaken during the conduct of a bed watch of a detained individual in hospital. Rule 33 of the Short-term Holding Facility Rules 2018 The Short-term Holding Facility Rules 2018 contains an equivalent notification obligation in respect of serious illness, severe injury or removal to hospital of a detained individual in a RSTHF.

7. Two different Home Office teams operate in IRCs:

• Detention Services Compliance team (Compliance team)

• Detention Engagement team (DET)

The Compliance team are responsible for all on-site commercial and contract monitoring work. The DETs interact with detained individuals face-to-face on behalf of responsible officers within the IRCs. They focus on communicating and engaging with people detained at IRCs, serving paperwork on behalf of responsible case-working teams and helping detained individuals to understand their cases and detention.

There are no DETs at RSTHFs, or the Gatwick PDA. Some of the functions which are the responsibility of the DET in IRCs, are instead carried out by the contracted service provider and overseen by the International and Returns Services (IRS) Escorting Contract Monitoring Team (ECMT) in RSTHFs. In the Gatwick PDA, the local Compliance team covers the role of detained individual engagement.

Purpose and scope

8. This instruction covers the initial notification of an in-patient admission, clinical updates during admission, bed watches, family liaison officer engagement, risk assessment and planning for discharge from hospital. It includes actions for CSPs, responsible case-working team, Home Office IRC teams, Detainee Escort and Population Management Unit (DEPMU), Escorting Operations and Healthcare providers. All further references to a detained individual being admitted to hospital in this instruction refer to an in-patient admission.

9. The guidance within this DSO applies only to those detained in an IRC, RSTHFs and PDA prior to transfer to hospital or when under escort.

10. Guidance for outpatient appointments which do not involve in-patient hospital admission is managed by separate guidance, DSO 07/2012 Medical Appointments outside of the Detention Estate.

Key terminology

In-patient admission

A hospital admission requiring the detained individual to stay one or more nights on a ward, triggering mandatory notifications and bed watch arrangements.

Adults at Risk (AAR)

Home Office policy framework for identifying and managing vulnerability in immigration detention.

Bed watch

A staffing arrangement in which contracted service provider (CSP) or escorting officers remain with a detained individual during a hospital in-patient admission to ensure safety, security, and compliance with detention rules.

Detention and Case Progression Review (DCPR)

An ad‑hoc or scheduled review conducted by the responsible case-working team to determine whether ongoing detention remains lawful, necessary, and proportionate, particularly following material changes such as hospital admission.

FLO (Family Liaison Officer)

A trained Home Office officer who becomes the main point of contact for the detained individual’s nominated emergency contact in cases of serious illness, life‑threatening injury, or hospice admission.

Psychiatric intensive care unit (PICU)

A secure mental health ward for individuals detained under mental health legislation due to acute psychiatric needs.

Procedures

General admission to hospital from an IRC, RSTHF or PDA

11. The following procedure is to be followed for general hospital admissions only. The process to be followed for people admitted to hospital under mental health legislation is set out in paragraphs 41-44.

12. The CSP and Healthcare provider must work together to update the Home Office on all developments, such as any clinical updates, treatment updates, security or management issues and planning or progress updates relating to ongoing admission to hospital, both when this is pre-planned and spontaneous.

Notification of admission

13. When a detained individual is admitted to hospital, without delay, CSP staff must notify:

• DEPMU, the local Compliance Teams and DET (for IRCs) and Escorting Operations (for RSTHFs) via the IS91RA Part C form with the date and time the detained individual was admitted to hospital, the address of the hospital and ward name/number. Clinical updates are the responsibility of the centre’s Healthcare provider as set out in paragraph 28.

• The Independent Monitoring Board (IMB) as soon as possible but within 24 hours (this can be done by phone, email or in person as appropriate).

14. Importantly, disclosure of clinical details would be contrary to patient confidentiality, and no identifying clinical information should therefore be disclosed when issuing notification of admission.

15. CSPs must consult, and where applicable follow, DSO 05/2015 Reporting and communicating incidents.

Actions for Home Office following notification

16. Where admission to hospital arises as the result of a life threatening or life changing (i.e. life is noticeably different afterwards compared to before) illness or injury, the Compliance team must bring this to the attention of the senior Home Office Managers (relevant HEO, SEO or Grade 7 for the IRC including, where relevant, the on-call manager / senior on call manager when DSO 05/2015 applies). If appropriate, the compliance team must engage the Home Office duty Family Liaison Officer (FLO) advising them of the detained individual’s emergency contact details (see DSO 08/2014 Deaths in immigration detention for further information on FLO engagement).

17. Upon receipt of the IS91RA Part C:

• DEPMU must record the details of the hospital admission on Atlas including the time and date of the detained individual’s admission to hospital, address of the hospital and ward name/number. After an individual has been admitted, DEPMU must also complete a bed watch proforma (this includes a request to review detention) and send this to the responsible case-working team.

• DET (Escorting operations in RSTHFs) must forward to the responsible case-working team and ensure that the case-working team has received the notification of admission to hospital and that the case-working team will conduct an ad-hoc detention and case progression review without delay.

• The responsible case-working team must conduct an ad-hoc Detention and Case Progression Review (DCPR) in line with the Detention - General Instructions and the adults at risk in immigration detention policy. The outcome of the DCPR must be notified to onsite DET and Compliance (or Escorting Operations) and updated on Atlas. If relevant, caseworkers may send the outcome direct to the detained individual’s legal representative. The service of the individual’s decision must be arranged in accordance with the “Service of immigration documents in secure mental health and hospital settings” standard operating procedure.

18. DEPMU must consider the viability of any future moves in place for the detained individual. DEPMU should cancel any inter-IRC moves if appropriate and liaise with the responsible case-working team should the detained individual have a notification of departure in place so the appropriate action can be taken.

Initial risk assessment and bed watch set-up

19. CSPs must undertake dynamic risk assessments when a detained individual is admitted to hospital or where there is a change in a detained individual’s clinical condition. This will include considering whether restraints (if used) should be removed in accordance with the provisions of DSO 07/2016 Use of Restraint(s) for Escorted Moves.

20. CSPs must provide officers for bed watch duties, unless otherwise agreed with DEPMU.

21. As per DSO 07/2016, when considering use of restraints for escorted moves/bed watches, an Escorting Risk Assessment form must be completed by escort staff, and a copy must be placed on the Detainee Transferable Document (DTD) and Person Escort Record (PER). The risk assessment must include details of the nature of the bed watch including any restraint used and consider the impact of any such measures on the detained individual’s privacy, their dignity, the effectiveness of any medical procedure/treatment and the safety of the detained individual, staff and others. The risk assessment must be regularly updated whenever there is a change to relevant circumstances including the expected length of admission, the detained individual’s mental and physical health, mobility and level of consciousness.

22. A PER is to be used during all escorts in addition to the Escorting Risk Assessment form. Observations of both key events during a detained individual’s in-patient stay and of other routine observations are to be recorded in the PER observation section by bed watch officers. The PER must be updated regularly to maintain a continuous record of the hospital admission. PER logs must be reviewed daily by the visiting IRC/ escort service provider manager (as per paragraph 7) to ensure they are being completed regularly, to the appropriate quality and in sufficient detail. A record of this review by a nominated manager must also be recorded in the PER. Copies of the PER must be made available to be viewed by the compliance team upon request.

Visiting arrangements and mobile phone access

23. The Escorting Risk Assessment form is to be completed when a detained individual is to be taken to hospital and must include consideration of how visits to the detained individual by friends and family can be facilitated. Restricting a visit to a detained individual in hospital must only take place in exceptional circumstances, such as where the individual poses a significant security risk, is undergoing critical medical treatment, requires isolation due to an infectious disease, or is experiencing a mental health crisis. Restricting a visit to a detained person in hospital can only be implemented with the authority of the relevant CSP duty manager and the Home Office Compliance manager (HEO and above). Full justification must be provided if visits are to be restricted and the reasons and authority sought recorded on the Escorting Risk Assessment form. The CSP duty manager must be notified of all visits prior to them taking place, ensuring they obtain details of any intended visitor(s), checks must also be made to ensure the visitor(s) are not currently banned from visiting the detained individual in accordance with DSO 04/2012 Visitors and Visiting Procedures. In certain medical circumstances the decision to restrict visits may be made by the hospital itself. If this is the case, it must be recorded within the Escorting Risk Assessment/PER and the CSP duty manager/Home Office compliance manager informed.

24. Working in conjunction with hospital staff, visiting arrangements are to follow similar safety and security protocols in place for IRC/RSTHFs where practical, i.e. confirmation of visitor(s) identification. Visitors are not to be searched while visiting detained individuals in hospital, though CSP staff must ensure the detained individual receives a level A search on their return to the centre, which must also be recorded. Monitoring of visits during hospital admission must be appropriately balanced in maintaining safety and security while affording a degree of privacy to the detained individual and their visitors, however, visual observations must always be maintained. Escorting staff are not permitted to leave the detained individual and visitor(s) unattended at any time.

25. Any changes to visiting arrangements set out in this DSO must be made with the CSP Centre Manager (or nominated deputy) and the relevant Home Office Service Delivery Manager’s (or nominated deputy) agreement, and such decisions must be recorded in the PER. Requests to deviate from the visiting arrangements set out in this DSO must only be made in exceptional circumstances (such as where the individual has displayed excessively aggressive or disruptive behaviour, or there is a risk of self-harm or harm to others).

26. A detained individual should also be permitted access to their mobile phone during hospital admission, and this should be considered and recorded within the Escorting Risk Assessment form (see DSO 05/2018 Mobile phones and cameras in immigration removal centres). In rare circumstances where it is deemed unsafe for the resident to retain access to their mobile phone, any restrictions imposed must be clearly recorded in the Person Escort Record (PER) by the CSP with full justification. Authorisation for such restrictions must be obtained from both the relevant CSP Duty Manager and the Detention Services Compliance Manager. Examples of situations where mobile phone access may be restricted include confirmed intelligence indicating the phone may be used for criminal activity; requests from medical staff due to interference with medical equipment; concerns about the phone being used to facilitate escape or coordinate disruptive behaviour; or risks of self-harm involving the device; this list is not exhaustive. Any changes to visiting arrangements or mobile phone access during hospital admission must be recorded in the relevant escorting paperwork.

Body worn or hand-held cameras

27. The use of Body worn cameras (BWC) or hand-held cameras (HHC) outside a centre, including in the hospital environment should only be where deemed necessary and in line with DSO 04/2017 Surveillance Camera Systems d in agreement with the hospital (for example, if the individual was physically aggressive during admission or under bed watch and attempts to harm themselves or others). However, body worn cameras must not be used during clinical examinations.

Clinical updates during admission

28. The relevant Centre Healthcare provider must obtain daily clinical updates for detained individuals admitted to hospital and should do so as soon as reasonably practicable after the hospital staff provide them. For individuals whose condition on admission is classed as critical, updates may be requested more frequently (e.g., every 4 hours). These updates should then be communicated without undue delay to the Home Office teams (Compliance and DET) and, where appropriate, to the IRC CSP Duty Manager, in accordance with DSO 01/2016 The Protection, Use and Sharing of Medical Information Relating to People Detained Under Immigration Powers.

29. Where specific clinical information cannot be shared on the grounds of confidentiality, an indication of the degree of seriousness of the detained individual’s condition and the likely length of hospital admission should be shared as set out in paragraph 30. The Centre Healthcare provider must make arrangements for the hospital to notify them as soon as possible of any significant deterioration in a detained individual’s condition.

30. On receipt of a clinical update indicating a significant and/or material change in the detained individual’s condition, the CSP must complete an IS91RA Part C form and submit this to DEPMU, Compliance (or Escorting Operations) and DETs. The DET team are responsible for forwarding the IS91RA Part C by email to caseworkers via the “Detained AAR Part C” inbox. his will trigger a case-worker action as referred to in paragraph 17.

31. Where there is a material change in circumstances that indicates the detained individual’s admission is critical or life‑threatening (or where a terminal diagnosis/hospice admission is being considered), and/or where the detained individual does not have capacity to communicate, the local Compliance Team (DEPMU/Escorting Operations in RSTHFs) should engage the duty Family Liaison Officer (FLO) to support communication with the emergency contact (next of kin).

Ongoing detention reviews

32. On receipt of notification or any daily updates from DEPMU, Escorting Operations and/or DET, responsible case-working teams must, without delay:

• Review the appropriateness of the detained individual’s continued detention at the earliest opportunity in line with Detention - General Instructions and the adults at risk in immigration detention policy. Daily detention reviews are not required, however ad-hoc DCPRs should be undertaken where there is a significant and/or material change in circumstances, i.e. deteriorating condition or readiness for discharge

• Update DEPMU/Escorting Operations /Compliance Teams of outcome of the detention review by email, confirming whether detention is to be maintained or release arranged. Where urgent operational action is required, this should be followed up by telephone

• Note all action/decisions taken on the detained individual’s Atlas record

• Arrange the service of their decision in accordance with the “Service of immigration documents in secure mental health and hospital settings” standard operating procedure (SOP).

Discharge planning

33. When a detained individual is to be discharged from an external Healthcare setting, all parties that were informed as part of the original admission notification process must be updated via the IS91RA Part C.

34. Where detention is to be maintained following discharge from an external Healthcare setting, the individual should normally return to the IRC, RSTHF or PDA from which they were originally transferred. Where the Healthcare provider and/or CSP considers that the individual’s ongoing healthcare or accommodation needs cannot be met at that centre, they must provide the local Compliance Team (and Escorting Operations in RSTHFs) with a written explanation of the specific needs that cannot be met, why they cannot be met, and what adjustments or arrangements would be required. The local Compliance Team (and Escorting Operations in RSTHFs) must then decide whether the individual can return with reasonable adjustments, or whether an MDT is required. Where an MDT is required, it must be arranged (a teleconference is acceptable where time constraints apply) and chaired by the local Compliance Team (and Escorting Operations in RSTHFs) to agree a clear plan. As a minimum attendance is required from the CSP, Healthcare provider, responsible case-working team and relevant Home Office operational teams. Formal minutes must be taken and shared with the responsible case-working team, who must upload the minutes to Atlas. A copy must also be retained locally by the CSP and shared with healthcare where appropriate. The MDT must include consideration of safeguarding issues, including where release from detention is being considered.

35. In the case of detained individuals who have been admitted to hospital during escort, DEPMU will liaise with the responsible case-working team to assist with decisions regarding ongoing detention.

36. For detained individuals released on immigration bail into the community directly from hospital or shortly after returning to a centre, it remains the responsibility of the CSP to provide a travel warrant to facilitate the detained individual’s return to the release address, unless medical advice is that the detained individual is not fit to travel on public transport. In this case, alternative arrangements must be made. Practical advice should be provided to the detained individual from the hospital clinician or the IRC clinician to encourage them to follow any aftercare advice and, where appropriate, on how to minimise the risk of infection.

37. Detained individuals must be provided with a letter from the CSP to the travel authority explaining the requirements of the travel plans and the existence of a travel warrant. This letter must contain contact details for the centre in case further confirmation is sought by the travel authority or if the detained individual requires further assistance during the onward journey. Release discussions should involve the FLO (where appropriate) who may need to maintain or re-initiate contact with the next of kin to make necessary arrangements for family support in the community. See DSO 01/2018 Release of detained individuals for more information.

38. Where a detained individual is released directly from hospital, the IRC Healthcare provider, in conjunction with the responsible case-working team, should follow the release instructions outlined in DSO 08/2016 Management of adults at risk in immigration detention.

39. If a detained individual is to be removed from the UK directly from hospital, the responsible case-working team must request written confirmation from the treating clinician that the individual is able to travel, together with advice on any special arrangements required to facilitate removal (for example, a medical escort, mobility aids or supply of medication). Where there is significant doubt as to fitness to be removed, caseworkers must seek confirmation from the relevant Healthcare provider before proceeding.

Admission under mental health legislation

40. In certain instances, detained individuals may be admitted to a secure hospital or Psychiatric Intensive Care Unit (PICU) under mental health legislation. In England and Wales, this would be under the Mental Health Act 1983; in Scotland this would be under the Mental Health (Care and Treatment) (Scotland) Act 2003; and in Northern Ireland this would be under the Mental Capacity Act (Northern Ireland) 2016.

41. When a detained individual is transferred to a hospital/PICU and they are detained under mental health legislation, they continue to be detained under immigration powers. ransfer under mental health legislation and admission to a hospital/PICU does not necessarily mean an individual’s immigration detention should be ceased. Immigration detention may be maintained if it is considered reasonable by the responsible case-work team (based on the individual facts of the case).

42. Where a detained individual is granted immigration bail during their admission to hospital or PICU, detention under immigration powers will cease. In those circumstances, section 48 of the Mental Health Act 1983 will no longer apply in England and Wales. Any continued detention for treatment must instead be authorised under the relevant mental health legislation for the jurisdiction in which the individual is receiving treatment. In Scotland, this is governed by the Mental Health (Care and Treatment) (Scotland) Act 2003. In Northern Ireland, the relevant legislative framework must be applied in accordance with local arrangements.

43. Healthcare staff must follow the published guidance applicable in the relevant jurisdiction. In England and Wales, this is NHS England » Guidance for the transfer and remission of adult prisoners and immigration removal centre detainees under the Mental Health Act 1983; in Scotland staff must follow introduction to volume 3 - mental health (care and treatment) (Scotland) act 2003: code of practice- volume 3 compulsory powers in relation to mentally disordered offenders - gov.scot (www.gov.scot). In Northern Ireland Healthcare staff should follow the Department of Health (NI) guidance titled “Transfer of Patients Detained under Mental Health Legislation between Hospitals in Northern Ireland and Great Britain.”

Transfers to PICU / secure hospital

44. All parties must make every effort to arrange and facilitate the transfer of any detained individual requiring psychiatric care as quickly as possible and within the 28-day guideline stated within NHS guidance. Instances where delays are encountered obtaining a suitable bedspace, or other delays which are a result of NHS handling, must be escalated to both the Head of Detention Operations and the local NHS Commissioners.

45. In Scotland, according to the Mental Health (Care and Treatment) (Scotland) Act 2003, a Transfer for Treatment Direction (TTD) must be executed as soon as practicable after it is made, and in any event within 7 days of the date on which it is made. If the TTD is not executed within this period, it ceases to have effect. Once a ‘MOJ warrant’/TTD has been granted, the IRC Healthcare must advise the local Home Office Compliance team and provide them with a copy and the time for the move to the agreed PICU. The Compliance team must without delay forward this information to DEPMU. DEPMU must task the contracted in-country escorting service provider to conduct the move.

46. Following completion of the transfer from the IRC to the PICU, the CSP must complete and submit IS91RA Part C to DEPMU, the local Compliance Teams and DET to notify the details of the admission to the PICU. Upon receipt of the Part C:

• DEPMU must record the details of the PICU admission on Atlas. They must consider the viability of any future moves in place and must also consider detention placement, future moves and removal impacts due to the hospitalisation. DEPMU should cancel any inter-IRC moves if needed and should liaise with the responsible case-working team should the detained individual have a notification of departure in place so the appropriate action can be taken.

• DET must forward the notification of admission to the PICU to the responsible case-working team, confirm receipt, and ensure that an ad-hoc detention and case progression review is conducted without delay.

• Case-working teams must conduct an ad-hoc DCPR in line with the Detention General Instructions and the adults at risk in immigration detention policy. The outcome of the DCPR must be notified to onsite DET and Compliance (or Escorting Operations) and updated on Atlas. If relevant, caseworkers may send the outcome direct to the detained individual’s legal representative. The service of the individual’s decision must be arranged in accordance with the “Service of immigration documents in secure mental health and hospital settings” standard operating procedure.

• Healthcare teams must maintain communication with the transferring IRC and the receiving hospital/PICU from admission to ensure progress, treatment (subject to paragraph 29), any remission plans are managed, and all parties informed.

47. Visits to individuals in England and Wales detained in hospital under the Mental Health Act 1983 (whilst also detained under immigration powers), following transfer under s.48 are governed by The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These regulations provide that these individuals must be facilitated to receive visits and must not be discouraged from taking visits out of their place of treatment where this is compliant with the visiting rules for the hospital/PICU in which they are detained.

Remission and return to detention

48. Remission to an IRC or RSTHF may be requested under sections 50, 51 or 53 of the MHA if the responsible clinician, any other approved clinician or a Mental Health Tribunal advises the Secretary of State for Justice that:

• treatment in hospital is no longer required; or

• no effective treatment is available in the hospital where the patient is detained.

49. In Scotland, this is referred to as revocation of the direction. When the patient no longer requires medical treatment for mental disorder in hospital in terms of the Act, the Scottish Ministers may revoke the direction (in accordance with sections 210 (2), 212 (3) or (4) or 215 (5)) and direct the return of the patient to prison, institution or other place in which the patient might have been detained.

50. In Northern Ireland, the discharge of a patient from detention is subject to Article 14 Mental Health (Northern Ireland) Order 1986. The patient is then transferred back to prison or released.

51. The remission/revocation process is incorporated in the guidance NHS England » Guidance for the transfer and remission of adult prisoners and immigration removal centre detainees under the Mental Health Act 1983.

Section 117 aftercare

52. When an individual requires aftercare on discharge from hospital/PICU and a Section 117 (S117) has been granted, a meeting may be arranged to discuss what aftercare is required. Attendees of the meeting may include the team that has been providing care to the individual while they have resided in hospital/PICU, members of the IRC Healthcare team where an individual may be returning to an IRC along with other professionals that may be required to support the aftercare of the individual once discharged from the hospital.

53. Once the S117 meeting is completed / decision of whether the person will be remitted to an IRC is made, DEPMU will arrange for the individual to be returned to the IRC in which they were last detained (unless it is concluded the individual’s needs could not be met at that location (see paragraph 34)).

Admission to a hospice

54. A hospice is a Healthcare facility or service that provides palliative and end-of-life care to individuals with terminal illnesses. The primary focus is on comfort, dignity, and quality of life, rather than curative treatment.

55. Hospices are staffed by medical professionals, including doctors, nurses, and support staff, who work to manage pain and symptoms and provide emotional, spiritual, and practical support to patients and their families. Importantly, a hospice is not considered a place of detention under The Immigration (Places of Detention) Direction 2021 (accessible version) - GOV.UK

56. The requirement for an admission to a hospice will be identified through clinical feedback. At that point, a multi-disciplinary meeting should be arranged and chaired by DET (and the relevant hospital, where appropriate) to determine onward actions and ensure all identified needs can be met. Formal minutes of these meetings must be recorded by DET and sent to the responsible case-working team, who must upload them to the Atlas. Without delay, on receipt of the formal minutes the responsible case-working team will be required to conduct an ad-hoc DCPR in line with the Detention - General Instructions Detention: general instructions (accessible) nd the adults at risk in immigration detention policy and take further action as per paragraph 17.

57. If a decision is made to transfer an individual into hospice care, they must be released from immigration detention.

58. The Healthcare and CSP must work together to continue to update the Home Office on all developments until the hospice admission. Following admission, a communication channel must be established between the Home Office and the hospice to receive updates on the individual’s condition. The hospice should be provided with contact details of the responsible case-working team and the centre Healthcare team and notified of any death. This ensures any death is considered in line with DSO 08/2014 - Deaths in detention and supports the Home Office’s obligations under the European Convention on Human Rights (ECHR) in any related investigation.

59. Where appropriate and where already engaged, the FLO will continue to support but would also contact the next of kin to notify them of the transfer of care (from hospital to hospice).

60. The CSP must notify the IMB of the admission as soon as practicable and within 24 hours (this can be done by phone, email or in person as appropriate).

61. All staff (IRC CSP staff, IRC Healthcare provider staff, Escorting Operations staff, DEPMU, Home Office IRC and case-working teams) are responsible for recording notifications and actions leading up to a detained individual’s hospice admission. This should be recorded in the most appropriate location e.g., Healthcare record, Atlas, PER or DTD each time an update is provided and then the document is closed appropriately on admission to the hospice.

Admission to hospital during escort (in-country / overseas)

62. In case of an individual becoming unwell during escort and then taken to a hospital’s A&E department by escort DCOs for emergency treatment before being admitted to hospital as an in-patient, the following procedure applies.

63. When a detained individual is admitted to hospital, without delay, the escorting provider must:

• Consult and where applicable follow DSO 05/2015 Reporting and Communicating Incidents.

• Notify DEPMU and Escorting Operations of the detained individual’s admission to hospital via the IS91RA Part C form with the date and time the detained individual was admitted to hospital, the address of the hospital and ward name/number, whether restraints are used and/ or whether an increased staff presence is required (changes to either of these measures must also be reported via IS91RA Part C as they occur), suspected or diagnosed illness, estimated or known duration of stay in hospital; and

• Agree provision and maintenance of ‘bed watch’ duties with DEPMU, for the duration of the individual’s hospital stay (requests for ‘bed watch’ and all associated coordination activity e.g. ‘bed watch’ updates and ‘future staff plans’ must be recorded on the escorting provider’s Escort and Detention System)

64. Notify the Independent Monitoring Board (IMB) as per DSO 05/2015 Reporting and communicating incidents.

65. During the ‘bed watch,’ responsibility for obtaining any significant updates on a detained individual’s clinical condition is the duty of the ‘bed watch’/escorting DCOs and must immediately be communicated via IS91RA Part C to DEPMU and Escorting Operations.

66. On receipt of notification of admission to hospital during escort, DEPMU will:

• Update Atlas as appropriate. If the individual is admitted for 24 hours, DEPMU will advise the responsible case-working team and send the bed watch proforma, advising of the admission and requesting the ad hoc detention review. This must also be brought to the attention of DEPMU Managers (relevant HEO, SEO or Grade 7 and where necessary, the Detention Operations and Escorting Operations on call officers when DSO 05/2015 Reporting and communicating incidents applies).

• Confirm bed watch arrangements are in place, and record all actions and notifications undertaken on Atlas.

67. If appropriate, DEPMU /Escorting Operation Managers (as above) will consider engaging the duty family liaison officer (FLO) where admission arises because of a life threatening or life changing illness or injury.

68. If engaged, the FLO will need to be advised of the detained individual’s:

• emergency contact details (see DSO 08/2014 Deaths in detention for further information on FLO engagement)

• admission to hospital (including where known, the suspected or diagnosed illness, the name of the hospital and contact telephone number, the estimated or known duration of stay, and the ward admitted to/contact telephone number).

69. After an individual has been admitted, for more than 24 hours, DEPMU must complete a bed watch proforma (this includes a request to review detention) and send this to the responsible case-working team.

Discharge from a Healthcare setting to a centre

70. Once the Escort Service Provider (ESP) is advised by the hospital that the individual is ready to be discharged, ESP will inform DEPMU. DEPMU must set a move from the hospital to an appropriate IRC/RSTHF without delay.

Family Liaison Officers (FLOs)

71. The Detention Services and Escorting Operations network of trained FLOs will be the main point of contact for the detained individual’s emergency contact (next of kin) where admission to hospital or a hospice is due to a serious and life-threatening illness or injury, including where this means the individual does not have capacity to engage. Details of the FLOs and co-ordinators are listed on the Detention Services and IRSC Escorting Operations weekly on call duty rota.

72. FLOs should be notified of a detained individual’s admission to hospital or hospice by phone in the first instance followed up by an email, as soon as possible, to the FLO inbox DetentionOperationsFLO@homeoffice.gov.uk. For admissions from an IRC or the PDA, this will be the responsibility of the Compliance Team and for admissions from RSTHFs it is the responsibility of Escorting Operations. The details that must be provided to the FLO include: detained individual’s name, emergency contact details, nominated contact point in the Compliance Team or Escorting Operations, information on use of restraints (if applicable), reason for admission to hospital or a hospice, the hospital/hospice that they have been admitted to and, where known, the ward name.

73. Where appropriate and required, the FLO will notify the detained individual’s emergency contact of their admission to hospital, maintain contact with the emergency contact throughout the detained individual’s hospitalisation, obtain updates on the detained individual’s condition from the Centre or responsible case-working team as appropriate, and provide practical support and information as requested by the emergency contact. The FLO will record all discussions with the next of kin in the FLO log.

Admission to hospital of a family member from the PDA

74. Where a dependent child is admitted to hospital, the parent should be permitted to accompany the child and suitable escort, and bed watch arrangements must be put in place to facilitate this. Consideration should be given to whether the child’s siblings should be permitted to accompany the primary parent too (for example to allow breastfeeding infant siblings to accompany their mother, or where the parent is a single parent and there is no other appropriate family member present and/or capable of caring for the child whilst the primary parent accompanies the hospitalised child. This list is not exhaustive, and consideration should be given on a case-by-case basis. Where siblings cannot appropriately accompany the parent, or where the parent is unable to care for remaining dependent children either at the PDA or at hospital, the CSP must provide ad‑hoc (usually short‑term) childcare. If the parent consents, the non-hospitalised child(ren) may be taken into the care of the local authority or cared for by a suitable family member in the community.

75. In the instance of a single parent family where the parent is admitted to hospital, the children are normally permitted to accompany the parent to hospital. In this instance, the parent maintains responsibility for the accompanying children. However, where this is not the case or would be inappropriate due to the parent’s condition, the Local Authority for children’s services must be contacted immediately to attend the PDA to take charge of any dependent child(ren). This notification is the responsibility of the designated PDA Child Safeguarding Manager. Notifications of hospital admission of a member of a single parent family should follow the processes set out above.

76. In either of the above scenarios the Family Returns Process (FRP) must be followed in respect of continued detention of the family.

Self-audit

77. CSPs require an annual self-audit of this DSO to ensure that the processes are being followed. This audit should be made available to the Home Office on request.

78. Home Office Compliance Teams must also conduct annual audits against their responsibilities stated within this DSO for the same purpose.

Revision History

Review date	Reviewed by	Review outcome	Next review
June 2026	Terry Gibbs	Implementation	June 2028