Healthcare: Yarl’s Wood

Kate Osamor Excerpts

Wednesday 6th January 2016 Westminster Hall

[Kate Osamor (Edmonton) (Lab/Co-op)]

I beg to move,

That this House has considered healthcare in Yarl’s Wood.

I am grateful for the opportunity to debate this issue today. Access to healthcare is a human right that is not adequately offered to the women of Yarl’s Wood. I formerly worked as a practice manager in the NHS, so I have seen for myself the importance of delivering good quality healthcare to communities, including providing access to consultation rooms where people are treated with respect and dignity. That is particularly important for detainees, who often have to undergo intimate examinations to document past torture.

Across immigration detention centres, there have been six High Court findings of inhumane and degrading treatment and nine deaths in custody in the past three years. According to Her Majesty’s inspectorate of prisons, the situation in Yarl’s Wood has worsened since G4S took over the contract for providing healthcare in September 2014. I want first to highlight the poor standard of healthcare provided, and secondly, to draw attention to the limitations that have recently been placed on independent doctors who are trying to work in Yarl’s Wood.

My demands to the Minister are as follows. First, the Government must lift the restrictions on access to Yarl’s Wood for independent doctors. The restrictions were put in place in October 2015, in contravention of detention rules. Secondly, they must ensure that legal rooms are refurbished, as has been done in other detention centres, to make up the extra space that Yarl’s Wood management says is necessary to accommodate independent medical visits. Thirdly, they must ensure that rule 35 is properly used. Rule 35 processes are meant to protect people from detention when they have been tortured, traumatised or are extremely vulnerable in other ways. I share the British Medical Association’s view that rule 35 reports should be written only by clinicians with relevant medical experience or appropriate training in identifying, documenting and reporting the physical and psychological signs of torture. Lastly, the Government must end the detention of pregnant women and those who are detained under the Mental Health Act 1983.

I want to start by highlighting the pervasive lack of confidence in the healthcare system. The detention services operating standards stipulate:

“All detainees must have available to them the same range and quality of services as the general public receives from the National Health Service.”

[Catherine West (Hornsey and Wood Green) (Lab)]

I thank my hon. Friend for bringing this excellent debate to Westminster Hall. Will she comment briefly on the recent debate in the Commons about the lack of a proper sentence, for want of a better word, which makes the question of healthcare even more important? If an individual does not know how long they will be in Yarl’s Wood, their healthcare issues will be even more intense and difficult to cope with.

[Kate Osamor]

My hon. Friend highlights an important point. I know from first-hand experience that if women do not know how long they will be detained, it has an impact on their mental health. I want the Government to take that fact very seriously. I will discuss it later in my speech. I thank my hon. Friend for raising that issue.

In 2014, the report “Detained” by Women for Refugee Women found that 62% of those surveyed described healthcare in detention as “bad” or “very bad”. In its latest report, “I am Human”, 17 out of 38 interviewees raised the issue of healthcare without being prompted. The urgent need to review healthcare was also voiced by HMIP. In its most recent report on its unannounced inspection, which was published in May 2015, it stated that healthcare in detention centres has declined severely. One of the two concerns it identified is healthcare, which needs to be improved. The second is that staffing levels are too low to meet the needs of the population, which links to healthcare. The report shows that staff do not have the time to build meaningful connections with detainees, and no counselling is available. It states:

“Detainees’ perceptions of health care were overwhelmingly negative. Their main concerns included poor access to prescribed medication, a poor overall standard of care, a poor attitude from health care staff, a corrosive culture of disbelief, and a lack of support with emotional and mental health needs.”

The Care Quality Commission issued three requirement notices following the inspection.

In November last year, I went inside Yarl’s Wood to meet women who had been detained. The two women I met were victims of trafficking; one was pregnant. Pregnant women are a particularly vulnerable group in detention. I call on the Government to review urgently their policy of detaining pregnant women in exceptional circumstances. In 2014, just nine of the 99 pregnant women who were detained in Yarl’s Wood were removed from the UK. The removal of pregnant women is rarely medically safe, due to potential pregnancy complications and increased levels of severe malaria on arrival.

The human reality has never been so clear to me as when I went inside the detention centre. I know that the Minister has already visited Yarl’s Wood, but I encourage him to do so again, if possible, on a healthcare visit.

[Mrs Caroline Spelman (Meriden) (Con)]

On the point about the unsuitability of detention for pregnant women and the statistic that the hon. Lady cited, there were 99 pregnant women in detention, but, as we understand it, there are now only two. I am sure she will join me in urging the Minister to ensure that no pregnant women are kept in detention, but the numbers have come down.

[Kate Osamor]

The right hon. Lady makes a valuable point. I agree that pregnant women should not be detained at all.

Meeting women in Yarl’s Wood allowed me to hear the concerns that they do not have the power to voice to the outside world by themselves. I am here today as their voice. This debate is for them. They told me, unprompted, that the worst thing about Yarl’s Wood is the healthcare. The women I met were depressed and exasperated by healthcare, but they were trying their best to stay positive about being released. They told me that the culture of disbelief in detention centres extends to healthcare staff as well, who are reluctant to take their illnesses seriously, and they assume that the staff are pretending to help with their asylum case. That feeling is compounded by the complaints process. Whereas the majority of complaints receive comprehensive replies, usually on time, healthcare complaints in the months prior to the HMIP inspection had either not been responded to or were extremely late.

I want to highlight how damaging such healthcare systems are for detainees who are victims of torture and those who have mental health issues. Unsurprisingly, those groups are often intertwined. They represent a significant proportion of those in detention. According to Medical Justice, 50% of those held in detention are asylum seekers or have sought asylum at some point in the immigration process. More than 80% of those surveyed by Women for Refugee Women for “I am Human” stated that they had experienced gender-related persecution, and 30% had been on suicide watch at some point during their detention. During the previous HMIP inspection, 49% said that they had problems of feeling depressed or suicidal on arrival, compared with 39% at the last inspection. Despite those needs, there is no counselling. Only 68% of staff said to HMIP that they received adequate training in safeguarding adults, and only one said that they were aware of the national referral mechanism for victims of trafficking.

Rule 35 is in place to protect the most vulnerable and ensure that they are not unsuitably detained, but it is failing in Yarl’s Wood. The most recent HMIP report states:

“Yarl’s Wood is failing to meet the needs of the most vulnerable women held. These are issues that need to be addressed at a policy and strategic management level.”

The report reiterates demands that rule 35 processes are appropriately followed. It states that Yarl’s Wood’s rule 35 reports were among the worst HMIP had seen. This included an exceptionally poorly handled rule 35 case in which a woman who had been raped was not considered to have met the criteria for torture even though she had clear symptoms of post-traumatic stress. Thanks to HMIP and independent organisations, the Government are aware of such concerns.

However, at the same time that the Government and Serco have announced reviews of operations at Yarl’s Wood detention centre, access to healthcare is limited. In October 2015, Yarl’s Wood informed Medical Justice that rooms in healthcare would be available only during a short lunch break on weekdays, severely restricting access for independent doctors, most of whom work in the NHS during the week and visit detainees on weekends. Such doctors therefore now have to visit detainees in inappropriate rooms with large windows and without examination facilities. That is wholly unsuitable. External medical assessments are most frequently carried out in order to assess whether someone has medical evidence of torture, which needs to be documented for their asylum case. If the doctor does not have a room where they can offer the woman the dignity of being able to undress and not feel threatened, how can that work?

[Nusrat Ghani (Wealden) (Con)]

Returning to the “I Am Human” report mentioned by the hon. Lady, these women are already feeling quite vulnerable. If they are pregnant, they will feel doubly vulnerable. If they have access to medical treatment, but with a male member of staff, that is another issue. Perhaps we need some information on the male to female staff ratio. These women are already vulnerable and they are being managed by male members of staff.

--- Later in debate ---

[Kate Osamor]

The hon. Lady makes a valuable point. As she eloquently said, the woman may have experienced trauma at the hands of men and then may have to sit and talk to a man and undress in front of him, which could double or triple the impact of what they have been through. It would be wonderful if the Minister could provide some data on the ratio of male to female members of staff.

Furthermore, medical appointments often take several hours, much longer than the newly restricted one-hour lunch-break slot. Thorough medical assessments are vital in light of the poor quality of healthcare and are instrumental in helping to identify the most vulnerable detainees. Medical Justice wrote to Yarl’s Wood in October 2015 about the matter and was told it was down to the Home Office. It subsequently wrote to the Home Office and has received no reply. I hope this debate will bring forward a proactive response.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the hon. Lady for securing this important debate. Does she agree that comprehensive trauma assessments for women necessitate a lengthy process over several sessions over a period of time, because people generally find it difficult to open up and discuss intimate details in a one-off consultation?

[Kate Osamor]

The hon. Lady makes a valuable point, and she knows from experience how much time it takes to be able to extract information when someone has been tortured. A one-hour slot is inadequate.

I want the Government to think about the harmful nature of detention as a policy, so I reiterate my requests that the Government lift restrictions on visiting times for independent doctors and refurbish legal rooms so that they can accommodate medical consultations in a dignified and professional manner; that they ensure that rule 35 is properly used to fulfil its function as a safeguarding mechanism for the most vulnerable; and that they end the detention of pregnant women and those detained under the Mental Health Act.

I hope that the Government will respond to my specific demands. I will say pre-emptively that while I welcome their efforts to address the matter through the Shaw review, its scope is limited. By not addressing detention as a policy, particularly for asylum seekers, it fails to deal with the root of many of the healthcare issues at Yarl’s Wood: detention exacerbates existing mental health issues, particularly for vulnerable victims of torture, and has a lasting impact on their wellbeing. It is important that the Government consider the long-term impact of detention on the mental health of ex-detainees when reviewing their policy, especially given that the latest figures collected by HMIP show that the number of women released into the community is more than double the number of women deported. Women who had been previously detained in Yarl’s Wood have told me of the devastating impact it has had on their mental health.

The Government must act now to improve a healthcare situation that has been severely criticised by women inside Yarl’s Wood, ex-detainees, and independent organisations. I particularly hope that my first demand regarding independent visits can be accommodated as a matter of urgency.