Health services assess and meet women’s health needs while in detention and promote continuity of health and social care on release. Health services recognise the specific needs of women as displaced persons who may have experienced trauma. The standard of health service provided is equivalent to that which people could expect to receive elsewhere in the community.

Strategy, clinical governance and partnerships

55. Women are cared for by a health service that accurately assesses and meets their health, social care and substance misuse needs while in detention and which promotes continuity of care on release.

The following indicators describe evidence that may show this expectation being met. They do not exclude other ways of achieving it.

  • Commissioning arrangements ensure that health, social care and substance misuse services are informed by and meet the assessed needs of the centre’s population.
  • Effective governance systems and partnership working between the centre, commissioners and providers ensure that health and social care provision meets the required regulatory standards.
  • Adverse incidents and near misses are reported, monitored and investigated.
  • Service delivery is informed by effective detainee consultation and lessons learned from adverse incidents/near misses, audits, complaints and case reviews.
  • Health staff are easily recognisable. Staffing levels and the skills mix meet service user need.
  • Women are treated by staff who receive relevant training, supervision and support to execute their roles and professional responsibilities.
  • Health staff recognise and promptly report any signs of trauma, torture or other health issues that affect fitness to detain and make all necessary referrals, including those under the National Referral Mechanism. Referrals are made with informed consent whenever possible.
  • Women are treated by staff who have received training in the health implications of gender-based violence, human trafficking, prostitution and migration.
  • Any women under the age of 18 have access to competent health staff with specialist skills.
  • Every patient has a single clinical record that meets contemporary record keeping standards.
  • Information is shared within the bounds of medical confidentiality to promote continuity of care and maintain patient safety.

56. Women receive safe, accessible, caring and compassionate treatment, which is sensitive to their diverse needs, from competent staff in an environment that promotes dignity and maintains privacy.

The following indicators describe evidence that may show this expectation being met. They do not exclude other ways of achieving it.

  • Women are treated with respect, compassion and cultural sensitivity while they receive care and treatment.
  • Women are referred promptly for appropriate care and treatment at external medical facilities where there is no available treatment for them in detention.
  • All women have equal access to health, well-being and social care services and are not unnecessarily restricted by language barriers, disabilities, location, security procedures or regime.
  • Women can request a health practitioner of their own gender and are made aware of this. If this cannot be facilitated at short notice, a female chaperone is used.
  • Women’s primary languages are recorded and professional interpreting services are used routinely for all confidential interactions with women who are not fluent in English.
  • There are sufficient rooms for the provision of appropriate and accessible care and women are seen in private, except in clearly documented exceptional circumstances.
  • Infection prevention and control measures are robust.
  • Competent health staff respond promptly to medical emergencies with appropriate emergency equipment.
  • All clinical equipment is appropriately maintained and serviced to ensure patient safety.
  • There are effective arrangements for gaining and reviewing the service user’s consent. When service users lack mental capacity to make a decision, health professionals make ‘best interests’ decisions in accordance with legislation.
  • Service users are kept safe and safeguarded from abuse, and have access to independent advocacy services if required.
  • Service users can easily complain, compliment or raise concerns about their care and treatment internally and externally and are protected from possible repercussions. Responses are timely, easy to understand and address all the issues raised.

57. Women are supported and encouraged to optimise their health and well-being.

The following indicators describe evidence that may show this expectation being met. They do not exclude other ways of achieving it.

  • There is a whole-centre approach to promoting health and well-being.
  • Information about available health services and current national health campaigns is easily accessible in all required formats and languages.
  • Women can easily access information and services that help them to optimise their health and well-being.
  • Women can access relevant national and local age-appropriate screening and immunisation programmes, including screening and treatment for blood-borne viruses if clinically indicated.
  • Women can access travel vaccinations and/or malarial prophylaxis if required, prior to deportation.
  • Older women receive proactive care from competent staff who understand their health, social care and well-being needs.
  • Women are advised of the risks of smoking and can access smoking cessation support, including self-care options similar to those in the community.
  • Robust systems are in place to prevent, identify and manage the outbreak of communicable diseases.
  • Barrier protection, contraception and sexual health advice are freely available while in the centre and on release.
  • Women receive relevant individual health promotion advice and resources on release.

Primary care and inpatient services

58. Women’s immediate health, substance misuse and social care needs are recognised on reception and responded to promptly and effectively.

The following indicators describe evidence that may show this expectation being met. They do not exclude other ways of achieving it.

  • A competent health professional screens all new arrivals promptly to identify their immediate needs and vulnerabilities, and assess their mental capacity. Appropriate onward referrals are made.
  • All relevant risk, vulnerability and care planning information is shared between centre and health staff, and the Home Office where necessary, on the first night and throughout a woman’s detention to ensure her safety.
  • With consent the patient’s medical records are obtained and any relevant care agencies are contacted promptly to ensure continuity of care.
  • Women who have vulnerabilities that indicate detention would be harmful receive a prompt and comprehensive assessment from suitably competent health professionals, which clearly states the impact of detention on their well-being.
  • Women receive a secondary health assessment from a competent health professional within 24 hours of arrival to identify and address their broader health and well-being needs, with further assessment to follow as appropriate.

59. Women’s individual ongoing health care needs are addressed through an appropriate range of care services. Continuity of care is maintained on transfer, release or removal.

The following indicators describe evidence that may show this expectation being met. They do not exclude other ways of achieving it.

  • Women can access primary care and social care services including mobility and living aids that meet their needs within similar waiting times to the community.
  • The appointment system ensures clinical time is used effectively and women do not have excessive waits in the health department before or after their appointments.
  • Women can access effective and responsive out-of-hours and emergency medical cover.
  • Women have easy access to a female GP, and unbiased evidence-based information services about choices in pregnancy are available to those awaiting discharge.
  • Women with long-term conditions and complex health needs (including food and/or fluid refusal) receive appropriate care, including regular reviews, in line with good practice, to support them to maximise their well-being.
  • Continuity of care is supported by effective care planning which routinely demonstrates patient involvement.
  • Health services staff provide community-based services on the wings when required.
  • Women requiring secondary care services are referred promptly and are seen within community-equivalent waiting times. Transfer or removal is curtailed to provide essential ongoing medical treatment.
  • Sufficient officer escorts are available to enable women to access secondary care services in a timely manner. Security measures during hospital escorts are based on an individual risk assessment and are proportionate.
  • In partnership with the centre, health staff promptly identify and respond to a deterioration in a woman’s physical or mental health or an increase in identified risks of harm, including advising the Home Office of the need to review the appropriateness of detention when required.
  • Comprehensive fitness to travel assessments, including the availability of required treatments in the country of destination and the implications of a lack of required treatments, are submitted to the Home Office in a timely manner.
  • Pre-release and removal assessments and interventions are provided in a timely manner based on clinical need. Women are given information on all relevant community support and are assisted to register with community health services if required.
  • Women being removed are given information about sources of support in the destination country.
  • Joint working with relevant centre departments, community agencies and escort staff supports effective continuity of care.
  • Health staff work collaboratively with the centre, Home Office and community services to ensure effective release planning for women with complex needs.
  • Women being released are offered a summary of their medical notes.
  • A summary of medical notes is given to escort staff in a sealed confidential envelope for women being removed.

60. Women requiring 24-hour nursing care are supported by a regime, facilities and health staff to meet their individual needs.

The following indicators describe evidence that may show this expectation being met. They do not exclude other ways of achieving it.

  • Detainees requiring 24-hour nursing care are not normally detained. If there are exceptional circumstances that result in them being detained, they are clearly documented. Women are released as soon as possible.
  • Health professionals admit and discharge women from 24-hour nursing care facilities using agreed clinical criteria.
  • Women receive a timely comprehensive assessment of their care needs and wherever possible are involved in developing their own care plans.
  • Women have access to normal centre activities, unless their clinical condition precludes it.
  • Women have access to therapeutic, meaningful and constructive activities to support their well-being and/or recovery.
  • Patients’ ongoing care needs are met following discharge from the unit.

Mental health

61. Women with mental health problems are identified promptly and supported by community-equivalent services to optimise their mental well-being during their stay and on transfer, release or removal.

The following indicators describe evidence that may show this expectation being met. They do not exclude other ways of achieving it.

  • Women with ongoing mental health needs have a review of their detention, which takes into account the appropriate therapeutic environment for treatment and evidence of the detrimental impact of detention.
  • Women receive an assessment of their immediate mental health needs on reception and appropriate onward referrals are made.
  • Women can easily access mental health services through a clear referral pathway and are seen within agreed response times for all mental health problems.
  • Referrals are reviewed promptly and appointments are allocated based on clinical need and risk.
  • Sufficient competent practitioners deliver an appropriate and timely range of culturally sensitive, evidence-based mental health interventions for all mental health disorders and trauma.
  • Prescribing reviews, including related physical health checks, occur as needed.
  • Women are assessed using a standardised format and additional information from other sources is obtained as required.
  • Women have written care plans which are regularly reviewed with their mental health practitioners.
  • In cases of co-morbidity there are clear care pathways in place for liaison and joint working with substance misuse services and primary care.
  • Women with severe and enduring mental illness are supported within the Care Programme Approach and, where clinically indicated, release to treatment in the community is arranged expeditiously.
  • Women with serious and enduring mental health problems who require treatment under the Mental Health Act are assessed and transferred promptly.
  • Women with severe mental illness are only separated on the recommendation of a suitably competent medical practitioner and only in exceptional circumstances, for the minimum time and with assertive mental health support.
  • Relevant information is provided to the receiving services on discharge from the mental health service.
  • Effective discharge planning and liaison with case workers and community mental health services ensure continuity of care and appropriate support following release into the UK.

Substance use treatment

The supply of illicit substances is curtailed and women with drug and/or alcohol problems receive effective individualised interventions to support their recovery.

62. An effective whole centre approach ensures that the demand for drugs and alcohol is reduced and that women can access appropriate treatment which meets the assessed needs of the population.

The following indicators describe evidence that may show this expectation being met. They do not exclude other ways of achieving it.

  • A multi-agency drug and alcohol committee develops, implements and monitors a strategic approach to drugs and alcohol and ensures effective joint working between all relevant stakeholders.
  • A regular and comprehensive needs assessment informs the strategy and action plans.
  • Staff receive training to enable them to recognise when a detainee requires a referral to substance use services, and there is a clear referral pathway.
  • During induction, newly arrived women receive information on substance misuse services and harm reduction.
  • Women have prompt access to psychosocial and harm reduction interventions which meet their individual identified needs, including mutual aid, such as trained and supervised peer supporters.
  • Effective intelligence and security measures guard against the trafficking or manufacturing of drugs or alcohol.
  • Sufficient competent staff provide effective evidence-based psychosocial and clinical services. Service user outcomes, feedback from service users and lessons learned from complaints and incidents inform service delivery and improvement.
  • Drug and/or alcohol-dependent women who are newly arrived receive prompt first night screening, plus regular additional monitoring and individualised treatment in their early days.
  • Specialist clinical staff complete a comprehensive assessment to determine a suitable management plan promptly after a detainee’s arrival or following a request for a clinical intervention.
  • Prescribing regimes are flexible, conform to national clinical guidelines and adequately meet the individual patient’s needs, including treatment availability following removal. Subject to confirmation, existing prescribing regimes are continued or equivalents provided.
  • Women receive regular multidisciplinary prescribing reviews and are actively involved in their own care planning.
  • During induction, newly arrived women receive information on substance misuse services and harm reduction around the use of illicit substances in the centre.
  • Women have prompt access to psychosocial and harm reduction interventions which meet their individual identified needs, including mutual aid.
  • Psychosocial and clinical substance misuse services are well integrated with each other and with primary and mental health services.
  • Service users receive information on harm minimisation and on service provision in their destination country in a language they can understand.
  • Effective discharge planning and liaison with relevant resettlement and community services, including in the country to which the detainee is being removed, ensure continuity of support following release.

Medicines optimisation18 and pharmacy services

63. Women receive community-equivalent person-centred medicines optimisation and pharmacy services.

The following indicators describe evidence that may show this expectation being met. They do not exclude other ways of achieving it.

  • Women’s medication histories, including allergies, are recorded during the initial reception screening and a full medicines reconciliation is completed within 72 hours of admission.
  • Any disruption in prescribing regimens is minimised and urgent/critical medicines can be accessed promptly.
  • Women have direct access to clinical pharmacy services and advice.
  • All medicines are handled, transported and stored legally, safely and securely with effective pharmaceutical stock management and use.
  • Alerts, drug recalls and adverse reactions to medicines are managed appropriately.
  • Robust governance processes ensure safe and effective medicines management, including monitoring of prescribing trends.
  • Women’s medicines are prescribed safely in line with evidence-based practice and agreed local protocols and administered at clinically appropriate times.
  • Patients’ adherence to medication is monitored and support given to maximise patient safety.
  • Women can store their medicines securely and self-administer safely following an in-possession risk assessment which is regularly reviewed.
  • Women can easily access simple self-care medicines at all times.
  • Medication is administered in an appropriate environment that ensures the safety of women and staff while maintaining patient confidentiality.
  • Women are given information about their medicines in a format they can understand and receive regular clinical reviews of their prescribed medicines in line with current guidelines.
  • Women are released or transferred with a confidential medical summary and sufficient medication for their needs, including for the duration of any escort journey.

18 ‘Medicines optimisation’ refers to a service that is responsive to individual needs. Simply put, it is about patients receiving the correct choice of medicine at the most appropriate time to address their individual needs.

Oral health

64. Women receive timely community-equivalent dental services, including oral health promotion.

The following indicators describe evidence that may show this expectation being met. They do not exclude other ways of achieving it.

  • Women have timely access to emergency dental services based on clinical need, and to the full range of NHS-equivalent treatment that can reasonably be delivered while they are detained.
  • Women receive evidence-based interventions in oral health promotion and disease prevention.
  • Women have prompt access to required medicines following dental interventions.
  • Governance processes ensure that women receive dental care that meets contemporary professional clinical standards in an appropriate environment.

Human rights standards

Health services
In relation to all health services expectations above: Everyone has the right to the enjoyment of the highest attainable standard of physical and mental health. See ICESCR 12. Human rights standards require that detainees be provided with the same standard of health care as available in the community and that places of detention should safeguard and improve the health of those in their care. See SMR 24, 25; EPR 39, 40; CPT 9; UNHCR–DG 8 [48(vi)].

In the context of immigration detention, it is important that the vulnerabilities of individuals are identified to ensure the impact of detention on vulnerable detainees is monitored and that they are safeguarded from harm. See standards relating to safeguarding of adults (in relation to expectations 7–11 above).

Strategy, clinical governance and partnerships
In relation to expectations 55–57 above: Human rights standards emphasise the role of health care staff in evaluating, promoting, protecting and improving the physical and mental health of detainees, paying particular attention to those with special health care needs. There should be an interdisciplinary team with full clinical independence. There must be prompt access to medical care in urgent cases and referral to external care when needed. See SMR 25–27, 31; EPR 40–42, 46.

Primary care and inpatient services
In relation to expectations 58–60 above: Human rights standards require detainees’ health care needs to be assessed on arrival, including identifying all health care needs, the risk of self-harm and any previous ill-treatment. See EPR 40; SMR 30. See additionally in relation to women, BR 6–8. Standards require health needs to be monitored and met throughout detention. See EPR 39–43, 46; SMR 31–34 and additionally in relation to women BR 10, 11, 18. See also standards relating to leaving detention (in relation to expectations 77–78 below).

Mental health
In relation to expectation 61 above: Human rights standards require places of detention to monitor and meet detainees’ mental health needs and to ensure referrals are made to external care when needed. See EPR 39–43, 46, 47.2; SMR 24–27, 31–34. See additionally in relation to women, BR 12, 13, 16.

Substance use treatment
In relation to expectation 62 above: Human rights standards provide that initial health assessments should include symptoms of withdrawal resulting from the use of drugs, alcohol or medication and note the need for continuity of care for drug dependence. See SMR 24.2, 30; EPR 42.3. See additionally in relation to women, BR 15.

Medicines optimisation and pharmacy services
See the standards under health services heading above.

Oral health
In relation to expectation 64 above: Human rights standards require detainees to have access to dental services. See SMR 25.2; EPR 41.5.