There are grounds for hope for improvement in detainees’ health treatment, but vigilance is still needed.
The NHS takeover of immigration detainees’ health care was perhaps the only positive news on 1 April, when the coalition’s ‘great benefits reform’ was inaugurated at the same time that most housing, debt, employment, social security and immigration advice and casework was removed from the scope of legal aid.
Problems with private health care
Private health care providers have been responsible for migrant detainees’ health care under contract to the UK Border Agency. The standard of care provided – which was supposed to match that in the NHS – has frequently been criticised as sub-standard. Medical Justice, Bail for Immigration Detainees (BID), the Bail Circle of the Churches’ Commission for Racial Justice and Her Majesty’s Inspector of Prisons are among the many organisations which have condemned the ‘institutional failure to address health concerns’ and ‘institutional resistance to evidence of torture’ in immigration detention. Dr Frank Arnold, former clinical director of Medical Justice, blames privatisation for the routine lack of essential medication for serious illnesses including HIV and diabetes, routine failures of investigation, examination and treatment of detainees’ medical conditions, and the routine cancellation of hospital visits when UKBA refuses to bear transport and escort costs – a state he describes as ‘institutional medical abuse’. A 2006 judicial review challenge to the detention of torture survivors revealed that the private health company which was supposed to vet all detainees for signs of torture within 24 hours of their arrival at Yarl’s Wood learned that this examination was not performed because UKBA didn’t think it was necessary, and so didn’t pay for it.
The need for vigilance
But a note of caution needs sounding. The fact that the NHS Commissioning Board is taking over from UK Border Agency does not necessarily mean the end of private – or sub-standard – health provision in immigration detention. It will be important for national and local detainee and asylum support groups to ensure that immigration detainees receive care and treatment to the same standard as NHS patients everywhere. As Hilary Pickles and Naomi Hartree note in the British Medical Journal, the change should result in an improvement in care, particularly for those detainees suffering mental ill health, but ‘robust commissioning is now needed’ to ensure detainees get the full benefit of the transfer.