This report was on an unannounced inspection of Brook House IRC between 20 May to 7 June 2019, and was published in September 2019.
“In terms of safety, levels of violence were low. However, there was a need to understand why instances of self-harm had significantly increased and respond to our survey finding that 40% of detainees said they had felt suicidal at some point while in the centre.” – Peter Clarke
General Points of Interest:
During the period from October 2018 to March 2019, 54% of detainees leaving Brook House were released into the community.
The number of self-harm incidents had risen significantly since the last inspection. During the previous six months, there had been 79 recorded incidents of self-harm compared to 46 at the previous inspection when the population was also markedly higher.
Over the same period, 167 Assessment, Care in Detention and Teamwork (ACDT) forms had been opened, which was proportionately more than at our the inspection. Injuries resulting from self-harm were usually superficial.
There had been 95 constant supervision cases in the previous six months.
The quality of ACDT documentation was deemed to be not good enough. Assessments and reviews were timely but care maps frequently lacked detail, case reviews were not sufficiently multidisciplinary and some post-closure reviews were not completed.
The number of detainees refusing food was high and there had been 388 cases in the previous six months. Since the previous inspection, detainees refusing food or fluids were no longer routinely monitored through the ACDT process.
The level of detainee-on-detainee violence was low and no serious assaults had been recorded in the previous six months. The level of assaults on staff was much higher than in other immigration removal centres, however these were generally minor and none were reported as serious.
Healthy Prison Outcomes:
|Preparation for Removal & Release||3||3|
|Rating||Outcomes for Prisoners|
|2||Not Sufficiently Good|
Key Points of Interest: Health, Well-Being and Social Care:
Most detainees were positive about health care, but a significant minority complained about their treatment and especially about the attitude of health care staff, often citing dismissive behaviour.
During the six months from October 2018 to March 2019, Brook House doctors had submitted 93 Rule 35 reports, 91 of which related to torture and two to the impact of detention on health, leading to 14% of those 91 reports to be released.
The latest annual infection control audit showed 97% compliance and areas of concern about governance were found to have been addressed.
Feedback from detainees was gathered through patient surveys in several languages and analysed at clinical governance meetings. Health staff also received feedback from detainees at the regular safer community meetings.
Detainees could complain about health services through several channels including a dedicated confidential complaints box in the health care waiting area, although this was not well promoted. Most complaints were received through the Home Office complaints system and then passed to health care, which potentially compromised medical confidentiality.
Difficulties with staff recruitment persisted, particularly RGN’s and HCA’s. On a positive note, Paramedics had now been added to the team.
The provision of recorded managerial and clinical supervision for health staff was inconsistent, and not in line with the policy. Both the quality and consistency of staff supervision records that were reviewed varied. Clinical supervision was being developed, including recent group sessions. Compliance with mandatory training requirements was good across the staff group and staff told the inspectors that they were well supported in using development opportunities.
All health staff had received intermediate life support training. Emergency equipment and medication were well maintained and checked regularly. Inspectors were informed that although custody staff were aware of code blue and red emergency protocols, they were rarely used, with other radio calls used to summon health care in an emergency.
The provider had developed and was starting to implement a health promotion strategy based on NHS national events. A health champion helped to promote health services to other detainees which was positive.
Access to primary care services was very good. Detainees waited no longer than 3 days for a routine GP appointment, with emergency appointments available each day. Nurses conducted daily walk-in triage clinics in the health care centre, and HCAs had recently started running regular well man clinics across the centre to improve engagement with detainees and offer health promotion advice.
DNA rates for primary care clinics were monitored. These were reducing and in April 2019 the rate stood at 14% for nurse-led clinics and 18% for GP clinics.
Two escorts a day were available for detainees requiring treatment at hospital. Cancellation rates were low at the time of the inspection.
All operational staff had received mental health awareness training as part of their initial training. Mental health first aid training had recently been introduced with the intention of rolling it out to all staff, which was positive. More than a third of staff had already received this.
An emotional health group was run by a clinical psychologist which included anxiety and depression. However, the group was for English speakers only.
A senior mental health nurse worked every weekday and there was a duty mental health nurse seven days a week. All urgent referrals were seen within 24 hours and routine referrals within 3–4 days, which was reasonable.
The recent implementation of the well-man clinic on the wings had identified mental health concerns which were referred to the mental health nurses and dealt with very promptly.
There was an average of 50 referrals a month and, at the time of the inspection, the team was supporting 32 detainees with varying levels of need. The DNA rate for individual sessions was high but these were actively followed up and further appointments offered. There was a symptomatic approach to post-traumatic stress disorder, which was appropriate given the unpredictable and short stay of detainees.
In the previous 12 months, 4 detainees had been transferred under the Mental Health Act – 3 within the agreed timescales of within 14 days, and 1 had exceeded this by 12 days.
Detainees with substance misuse problems were referred for an assessment promptly on reception. The demand for clinical prescribing for drug and alcohol dependence was low and detainees were given appropriate support. Prescribing for opiate dependence focused on reduction, although prescribing was flexible and patients were involved in treatment decisions with regular reviews. At the time of the inspection, only 1 detainee was receiving opiate substitution therapy and was on methadone. A further 2 detainees were detoxing from alcohol and had received good care with regular checks throughout the first 5 days of treatment.
A team leader and two psychosocial workers screened all new arrivals and offered individual and group work. At the time of the inspection, the team were supporting 20 detainees. Access to psychosocial interventions was good, with effective use of 2 peer supporters who ran drop-in sessions on each wing to promote the service. They also participated in weekly workshops which covered a range of topics including alcohol, cannabis awareness and psychoactive substances.
There was evidence of a small amount of illicit drug use in the centre, mainly cannabis and psychoactive substances (NPS). Health care kept a log of suspected use of NPS. During 2019, there had been 5 episodes in both March and May whereby detainees needed observation.
The substance misuse team delivered monthly training and awareness sessions for custody staff on substance misuse, including the effects of NPS. All custody staff had received this training, which was commendable.
A pharmacy technician worked every weekday and managed the pharmacy efficiently. Since October 2018, a pharmacist had been visiting for 4 hours each week to give professional oversight of the service.
About 60 to 70% of detainees on medication received it in-possession following an appropriate risk assessment.
A Dental Officer from East Surrey Hospital attended the centre fortnightly to assess patients and provide oral health advice. Detainees requiring urgent treatment were referred to hospital dental clinics at weekends. Detainees waited approx 3 weeks for a routine assessment and could access emergency care daily at Crawley Hospital.
There were no on-site dental facilities and the provider was considering engaging a mobile dental service to improve access to dental treatment.
As part of the survey, 38% of prisoners rated the overall quality of the health services as being either very good or quite good.
Recommendations: Health, Well-Being and Social Care:
- Health care complaints system should be well advertised and ensure that medical confidentiality is maintained.
- All health staff should receive regular, recorded managerial and clinical supervision.
- The centre should promote the emergency protocols to ensure that all custody staff are familiar with them and are confident to use them when needed to prevent confusion and potential risk.
- A wide range of translated health information, including self-help guidance, should be easily accessible and clearly promoted.
- Formal monitoring should be introduced to ensure that all detainees leave the centre with their prescribed medication.
Good Practice: Health, Well-Being and Social Care:
- The introduction of well-man sessions across the centre was a positive initiative to improve engagement with the service and offer health promotion advice.
- There was effective use of substance misuse peer supporters who ran drop-in sessions on each wing to promote the substance misuse service. They participated in weekly workshops which covered a range of topics including alcohol, cannabis awareness and psychoactive substances. A detainee ‘health champion’ also helped to promote health services.
CQC Requirement Notices Issued: