This report was on an unannounced inspection of Colnbrook IRC between 17 Nov to 07 Dec 2018, and was published in April 2019.
“While some aspects of health care remained underdeveloped, such as governance and services for those with low-level mental health needs, the previous chronic staff shortages were being alleviated and the overall service was now reasonable.” – Peter Clarke
General Points of Interest:
During the previous 6 months, an average of 124 detainees arrived each week.
The average total length of detention for detainees at Colnbrook at the time of our inspection was 75 days, longer than other immigration removal centres, with 7 having been held for more than a year, and 2 of whom had been in detention for over 2 years.
During the previous 6 months, 2,965 detainees had left the centre, 58% of whom had been removed from the UK, 19% transferred to another immigration removal centre and 23% released into the community.
Incidents of self-harm had increased very significantly. During the previous 6 months, there had been 65 incidents of self-harm compared with 20 in the same period in 2016 when the population was also markedly higher.
In contrast, 168 ACDT forms had been opened, fewer than at the previous inspection.
Healthy Prison Outcomes:
|Preparation for Release & Removal||4||4|
|Rating||Outcomes for Prisoners|
|2||Not Sufficiently Good|
Key Points of Interest: Health, Well-Being and Social Care:
There were arrangements for consultation with detainees and evidence that some changes had occurred as a result of their suggestions. Patient satisfaction surveys were available in 15 languages.
The chronic staff shortages previously experienced by the health team had improved. Although there were still vacancies, a rolling recruitment programme had generated new staff and regular bank and agency staff were used to cover shortfalls. Not all staff received regular formal clinical and/or managerial supervision and the Trust was not following its supervision policy in terms of frequency and maintaining records of supervision meetings.
An annual infection control audit showed 87% compliance and areas of concern were being addressed. A range of health promotion information was displayed but in English only, which limited its accessibility to detainees. Professional telephone interpreting was not used consistently for health care consultations and some detainees interpreted for their peers, compromising confidentiality and accuracy.
Access to vapes and smoking cessation support was available, although waiting times were long. Relevant disease prevention and screening programmes, treatment for blood-borne viruses and travel vaccinations were available if required but uptake was low. Barrier protection was available but detainees had to request this from health care staff.
All new arrivals saw a GP within 24 hours. The door was left open during some reception screenings that we observed which compromised privacy.
Responsive nurse triage clinics were held twice a day and met detainees’ health care needs, although most detainees stated they preferred to see a GP in the first instance. Health care services provided 24-hour cover, with 2 nurses covering night duty. There was a good range of health professionals, and waiting times were reasonable.
GP services were delivered 7 days a week. Waiting times for routine GP appointments were low and most detainees were seen within 48 hours, which was good. Detainees had prompt access to Rule 35 assessments. GPs had undertaken training on completing Rule 35 reports, and health care staff knew how to respond to safeguarding concerns.
The use of the NHS England Quality Outcome Framework (QOF) helped to support the identification and monitoring of long-term conditions. This was overseen by the primary care lead. GPs managed and reviewed detainees with long-term conditions and nurse triage clinics provided supplementary support.
Unusually, detainees requested health care appointments through detention officers. While this did not delay treatment, patients did not have equitable access to health care services and confidentiality could be compromised.
No social care provision was available and inspectors were told that detainees with social care needs would not be held at the centre, which was in contrast to Inspectors being made aware of a few detainees at Colnbrook who had such needs.
An integrated mental health team delivered a stepped model of care. There were some vacancies in the team and it was still a weekday service, although plans were in place to address this. A daily team referral meeting now took place which ensured prompt referral to the relevant team member. Routine referrals were seen within 3 days and urgent cases within one day. An effective, well-managed weekly multidisciplinary team meeting discussed on-going care and prioritised risk. There was good follow-up of detainees who did not attend appointments.
The consultant psychiatrist, who delivered 4 sessions a week, was very proactive in providing the Home Office with supplementary information about detainees with special needs.
The service offered a psychologically-led approach to mild to moderate problems, which included guided self-help material. This was only in English. The psychology team completed post-traumatic stress disorder assessments and informed the Home Office if detention was considered detrimental to the person’s condition.
A ‘Team of Life’ workshop was a positive initiative: 12 detainees took part in this workshop which used football as a medium to look at skills, strengths, resilience and hope for detainees who had experienced traumatic experiences. The second workshop was being held at the time of the inspection and the intention was to run similar events every quarter.
Support for detainees under ACDT case management had improved and there was a daily rota for a mental health nurse to attend reviews. Two beds had been identified at the local psychiatric intensive care unit, and detainees requiring hospital treatment could access care more promptly.
The mental health team leader delivered regular mental health awareness training to custody officers and all new staff received training. Annual refresher days were planned, which was positive.
The centre did not have an effective joint agency substance misuse management strategy. However, drug and alcohol finds were highlighted at security meetings which the psychosocial team manager attended.
Detainees with substance use problems were referred promptly on reception for a detailed assessment. Prescribing for opiate dependence usually focused on reduction. Prescribing remained flexible and patients were involved in treatment decisions with regular joint reviews and care plans in place. At the time of the inspection, 4 detainees were receiving opiate substitution therapy, with 2 on methadone and 2 on buprenorphine.
Any detainee withdrawing from alcohol was not admitted to the centre and was either sent to Harmondsworth IRC where there was an enhanced care unit or to hospital for treatment.
The pharmacist clinically reviewed all prescribed medicines before ordering them and medicine reconciliation was undertaken promptly. The pharmacist undertook medicine use reviews and patients could ask to see the pharmacist.
A custody officer was allocated to supervise the health centre each day, including medicine administration. The quality of interaction varied: some officers were very good while others were perfunctory, with little interaction with detainees.
Records of fridge temperatures indicated that medicines were stored safely, although there were a few gaps in the records.
Medicines were administered 4 times a day between 8.30am and 9pm and medicines required more frequently were facilitated. SystmOne was used for prescribing and administration of medicines. Records that we looked at were complete and non-attendance was followed up. A weekly critical medication report provided an additional safeguard that medication had been received by the patient and omissions were followed up.
About 50% of detainees on medication received it in possession following risk assessment.
As part of the survey, 24% of prisoners rated the overall quality of the health services as being either very good or quite good.
The CQC issued one Requirement Notice against Regulation Standards.
Recommendations: Health, Well-Being and Social Care:
- Health care staff should have regular recorded clinical and managerial supervision.
- Health information, including health promotion material, should be available in a range of languages and visible signs should promote the availability of translated material.
- The use of professional telephone interpretation should be used more consistently and detainees should not be used as interpreters in confidential health appointments.
- The automated external defibrillators (AEDs) available to centre staff should be regularly checked via a robust monitoring system and all staff on duty should know the location of the nearest AED.
- The range and frequency of interventions for detainees with mild to moderate needs should be increased.
- Detainees who are experiencing severe and acute mental illness should not be in immigration detention.
Good Practice: Health, Well-Being and Social Care:
- The ‘Team of Life’ workshop was a positive initiative to help detainees who had experienced traumatic experiences to focus on their skills, strengths, resilience and hope through physical activity and psychological interventions.
CQC Requirement Notices Issued:
Regulation 17 Good Governance. How the regulation was not being met:
- Supervision arrangements were limited, inconsistently applied and were not reviewed as part of the overall governance systems and processes of the trust.
- Some staff had not attended supervision sessions for a number of months, other staff did not access regular supervision sessions in line with the trust’s policy and recording of supervision sessions were not consistently maintained.
- Not all staff including clinical leads accessed regular supervision in line with the trust’s Clinical and Managerial Supervision Policy
- Records of individual staff supervision sessions were not consistently maintained.
- The systems and processes did not fully assess, monitor and mitigate some risks relating to the health, safety and welfare of people using services and others.
- The Trust’s Health Delivery Action Plan (HDAP) had previously identified in March 2018 that professional translation and interpreting services should be used in all cases where confidentiality or accuracy was required.
- Despite their availability, interpretation services were not used consistently during health care consultations. Detainee peers were sometimes used as interpreters and this compromised patient confidentiality.
- Written information about healthcare services was not available in alternative languages or in an accessible user-friendly format.