Healthcare in Detention

1
Healthcare in Detention

• 24th February 2006
• Hyatt Regency Hotel, Birmingham
• Dr Geraint Thomas, Partner
• Saxonbrook Medical, Maidenbower

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Dr Geraint Thomas

• Senior Partner GP practice in Crawley
• Time for a Change a new way of working
• Involved with Immigration since 1995
• Lead Clinician Tinsley House IRC

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Areas to Consider

• Background of Detention
• The Detention Estate
• Legislation affecting Healthcare
• Practical Solutions to Requirements
• Screening
• On-going issues
• Communication

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Background of Detention

• Previously long term
• Now short term
• Re-badged REMOVAL Centres
• Consequential change in healthcare options in
  centres

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The Detention Estate

• 2450 Beds
• 2000 Males 450 Female
• 11 Centres (range 16 501)
• 5 Operators
• HMP 4 private contractors

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The Detention Estate

• England
• Dover (362 beds)
• Portsmouth (160 beds)
• Gatwick (137 beds)
• Heathrow (501 296 beds)
• Oxford (184 beds)
• Cambridge (265 beds)
• Bedford (270 beds)
• Manchester (16 beds)
• Doncaster (112 beds)
• Scotland
• Dungavel (148 beds)

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Legislation affecting Healthcare

• Immigration and Asylum Act 1999
• Detention Centre Rules
• Guidance Notes
• Operating Standards
• Operating Contract

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Immigration and Asylum Act 1999

• Defines ability to detain
• Outlines management obligations of detention
  centre

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Detention Centre Rules

• Law from 2001
• Cover all aspects of centre operation
• Section on Healthcare Provision
• Basic standard equivalent to NHS

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Rules Guidance Notes
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Summary of Rules

• Initial physical and mental assessment within 24
  hours arrival
• Consider torture and illnesses affected by
  detention and advise Immigration
• Assess detainee if thought risk to others from
  infections
• Provide professional service

12
Operating Standards

• Broader guidance
• Defines audit criteria
• Requires self harm / screening assessments within
  2 hours
• Requires link to wider NHS services

13
Operating Contract

• Response to operating requirements of Immigration
  for each Centre
• Commercial variations
• Define local practices
• Reflect staffing levels

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Practical Solutions to Requirements

• Screening
• Open access
• Links to NHS
• Discharge Process

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Screening Examination

• Within 24 hrs, some parts within 2 hrs
• Many been in UK long time
• Some unmet need
• Failure to engage with GP / Healthcare
• Ongoing treatment information
• Access to medical records
• Existing OPD kept where practical

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Disease Prevalence
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Open Access

• Ongoing and new issues
• Chronic Disease Clinics
• Daily sick-call
• Nurse triage
• Doctor reviews
• Out of Hours
• Specialist links

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Centre Morbidity
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Stress in Detention

• Medication
• Psychology support
• Daily environment
• Purposeful activity
• Religious support
• Good food
• Pleasant ambiance

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Links with NHS

• Work closely with PCT and Public Health
• Local follow up of existing issues
• Local expectations of no queue jumping
• Waiting list restarts
• Consequent medical holds
• Maintained remote OPD

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Discharge Process

• Alternative centre
• Full records sent and care plan followed
• Admitted to UK
• Records given with advice on how to contact
  Primary Care Services and outline care needed
• Returned overseas
• Records given with outline of care needed

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Communication

• 11 Healthcare teams 1 Goal
• Healthcare Steering Group
• Standards
• Audits
• Liaison with
• Immigration
• Prison Health

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Dr Geraint Thomas

• Saxonbrook Medical
• Maidenbower Square
• Maidenbower
• CRAWLEY
• West Sussex
• RH10 3HY
• Tel [phone]
• geraint_at_saxonbrook.co.uk