Guidance

Medical appointments outside of the detention estate (accessible version)

Updated 7 August 2020

Introduction

1. This order provides guidance for all staff in Home Office immigration removal centres (IRC), pre-departure accommodation (PDA) and short-term holding facilities (STHF) and escorting staff on the management of medical appointments for those in detention outside of the immigration detention estate.

2. Two different Home Office teams operate in IRCs:

• Detention and Escorting Services Compliance team (Compliance team)
• Immigration Enforcement Detention Engagement team (DET)

The Compliance team are responsible for all on-site commercial and contract monitoring work. The DETs interact with those in detention face-to-face on behalf of responsible officers within the removal centres. They focus on communicating and engaging with people detained at IRCs, helping them to understand their cases and detention. DETs are managed by an on-site Home Office DET manager.

There are no DETs at residential STHFs, functions which are the responsibility of the DET in RSTHFs are carried out by the Escorting Contract Monitoring Team (ECMT). In the Gatwick PDA the role of detainee engagement is covered by the local Compliance Team.

Attendance at external medical appointments

3. Every effort should be made to keep and fulfil existing external medical appointments already in place for those in detention, both those arranged prior to and during detention. This is especially important in the case of pregnant women and those requiring investigation or ongoing treatment for chronic or long-term conditions.

4. Centre healthcare teams must ensure that they notify the Detainee Escorting and Population Management Unit (DEPMU) of external medical appointments in place for those in detention by submitting an IS91 Part C to the DEPMU inbox, and a copy provided to the centre supplier and both the onsite Compliance and Detention Engagement teams.

5. If there are operational difficulties with carrying out an escorted movement for an individual in detention to attend an external medical appointment, the centre supplier must liaise with the centre healthcare team. If a solution is not agreed and the appointment has to be cancelled, then both the Compliance and DET SEO or HEO should be informed. In such cases, this should be explained to the individual and every effort should be made to arrange a new appointment as soon as practicable.

6. Individuals should normally be given a minimum of 24 hours advance notice of the timing of outside medical appointments. Centre managers may only refrain from notifying an individual of the timing of a medical appointment if there are security concerns relating to the specific detained individual. This will inform the risk assessment which must take full account of clinical considerations. Where a individual is assessed to present a control or security risk, including escape, but the healthcare team confirm that the appointment should not be missed, escorting staff should make appropriate arrangements to keep any risk to a minimum (for example, using additional escort staff).

7. Providing those in detention with advance notice is particularly important if failure to notify an individual of an appointment puts him/her at risk or means that the planned clinical procedure cannot take place, e.g. the medical procedure requires the individual to have abstained from food/fluids prior to the appointment.

Medical appointments made prior to detention

8. The following principles should apply to all outside medical appointments made prior to the individual entering detention:

• healthcare should consider each case on an individual basis
• all medical appointments arranged prior to detention should be kept wherever possible
• if such an appointment does have to be cancelled, another one should be promptly arranged at a suitable clinic or hospital as soon as practicable.

9. Where appointments are at a clinic or hospital where the distance to the location or the duration of the treatment would require an overnight stay, the final decision as to whether an appointment is kept should be made by the healthcare team taking into consideration the circumstances of the individual (for example, how urgent the appointment is, whether it could be re-arranged at a closer hospital or clinic without undue delay or detriment to the individual’s care or treatment). If the decision is taken that the appointment needs to go ahead, the healthcare team should submit a request to DEPMU to arrange a move to a nearer centre to facilitate the appointment.

Transfers

10. If a transfer to another centre is required, DEPMU should check if an external medical appointment is in place for an individual before arranging a transfer and continuity of the individual’s clinical care must be considered.

11. If the circumstances of the appointment are unknown, DEPMU should seek advice from healthcare as to whether the appointment should be kept and healthcare should provide justification for this advice within the confines of medical confidentiality (refer to DSO 01/2016 Medical Information Sharing). Transfers of those in detention prior to appointments taking place should be kept to a minimum.

Removals

12. Unless there is a need for an assessment to be undertaken regarding a detained individual’s fitness to fly (refer to DSO 01/2016 Medical Information Sharing), medical appointments are not a barrier to removal. Where appointments cannot be kept because removal from the UK is scheduled to take place beforehand, and the centre healthcare team have deemed the appointment important in responding to clinical need, for example the exploration of symptoms, operations/treatments or follow up procedures, the individual should be provided with a letter to pass to those responsible for providing healthcare in his/her country of origin. Where appropriate, healthcare staff should also provide the detained individual with copies of their medical records and x-rays or blood tests to accompany the letter.

Private medical appointments

13. Private medical appointments arranged by a detained individual or their representative fall outside of this DSO. Any such arrangements to facilitate private appointments should be dealt with locally by the centre.