Purpose of this document
This document sets out the partnership agreement between The Home Office, UK Health Security Agency (UKHSA), the Department of Health and Social Care (DHSC) and NHS England.
A partnership agreement has been in place to support the commissioning and delivery of healthcare in health and justice since the introduction of the Health and Social Care Act (2012). The Health Partnership (of NHS England, UKHSA and the Home Office) has already achieved many improvements to the commissioning and delivery of healthcare across the removal estate in Immigration Removal Centres and Short-Term Holding Facilities.
In the new agreement set out in this document, the original tripartite partnership, has been joined by the Department of Health and Social Care. This marks the establishment of an even stronger level of co-operation and cohesiveness between all of those who can impact on policy, commissioning and delivery of health services across the removal estate.
This agreement covers health services in establishments in England only.
This national partnership agreement includes:
- The defined roles of the four partners
- Our commitment to working together and sharing accountability for delivery through our linked governance structures
- Our core objectives and our priorities for 2022 – 25, and a link to the workplans that provide the details of the activities to deliver our 10 priorities
- How we are working together to improve our data and evidence so that we can make better understand the health needs of detainees and make more effective and efficient decisions.
Who we are
Our partnership helps us to collaborate and align our priorities, although we are five independent organisations with specific roles.
- Home Office: Immigration Enforcement’s immigration removal estate
- UK Health Security Agency (UKHSA): Health protection expertise, advice/guidance and support
- NHS England: Health service commissioner
- Department of Health and Social Care/Office for Health Improvement and Disparities: Health Policy
How we work together
We are jointly committed to and accountable for delivering shared objectives.
We recognise our respective statutory responsibilities and independence, but we must work together to ensure safe, legal, appropriate and effective care that improves health outcomes for people who are held in the removal estate irrespective of how long they remain in establishments. We commit to collaborate and cooperate at all levels within our organisations to achieve our shared priorities and deliver our joint workplan.
- Appropriate governance structures support delivery of our joined priorities.
- The Immigration Removal Centre (IRC) Healthcare Partnership Group (England) has responsibility for the oversight and on-going management of this agreement and delivery of our shared objectives. It oversees partnership risks and their mitigation and enables dispute resolution. From 2020 the IRC Healthcare Partnership Group has been co-chaired on rotation by each of the partners and this approach will continue.
- Governance at establishment level is provided through the development and operation of Local Delivery Boards (LDBs),( led by the Home Office Service Delivery Managers and including providers of detention services, healthcare and healthcare commissioners) and Centre Partnership Boards (CPBs) led by healthcare commissioners. The work of LDBs and CPBs should be underpinned by a local delivery agreement to set out how partnership work is taken forward at a local level to support delivery.
- Organisational governance structures exist in each individual organisation, which will be used to ensure decisions that impact on organisational spending and delivery are signed off appropriately. Each member is responsible for ensuring decisions are signed off and information is disseminated through the proper channels.
What we are committing to deliver
Our partnership is underpinned by two core shared objectives:
- Detained individuals should receive high quality healthcare services, commensurate to standards of community services, appropriate to their needs and reflecting the circumstances of detention. Health care services include those aimed at disease prevention and health protection interventions. These services are to be made available based on clinical need and in line with the Detention Centre/Short-term Holding Facility (STHF) Rules.
- Health and wellbeing services in immigration removal centre (IRCs) should seek to improve health and wellbeing (including parity of esteem between services which address mental and physical health), tackle health inequalities and the wider determinants of health.
How we work together
We will deliver our partnership objectives of further improving care and reducing risk of self harm to detainees through focusing on 10 key priorities:
1. Improve the mental health of detained individuals through assessment and provision of care and support commensurate with that of the wider community, supporting a menu of provision through a pathway of trauma informed interventions to meet need and improve patient outcomes and to ensure the potential impact on the mental health of individuals of communicable diseases is accounted for in the recovery and restoration of services and additional care needs.
2. Improve the pro-active detection, surveillance and management of infectious and non-communicable diseases in the immigration removal centre (IRCs) to improve capability to detect and respond to outbreaks and incidents.
3. Building on the response and learning from the COVID–19 pandemic there is a real need to recognise the value of partnership work in identifying and managing detained individuals who present at risk of serious self-harm. It is essential to ensure there is clarity across health and secure pathways including primary mental health intervention, appropriate and effective use of assessment care in detention and teamwork (ACDT), constant supervision and assessment and treatment of identified vulnerable detained individuals. In building on practice sharing arrangements which support the safer management of a detainee we will ensure the best outcomes for this patient population.
4. Align NHS England and Home Office Immigration Enforcement commissioning systems and strategies to ensure quality.
5. Ambition towards creating a smoke free detention estate mindful of the population and their experiences and working towards trauma informed delivery.
6. Continue work at all levels to reduce the impact of substance misuse (including from the use of psychoactive substances), to address the risks of misuse and resultant harms, and to ensure the right help is available at the right time and to support the dependency management of individuals being returned to their countries of origin.
7. To secure a collaborative approach between removal centre staff and Healthcare staff to educate and secure the understanding of detained individuals being released into the community of what healthcare is available to them and how they can access Primary Care or emergency services.
8. To support the effective management of the continuity of care for detained individuals being removed from detention centres in England by ensuring that all returning detained individuals have access to up to 3 months medication at their point of removal and all those released into the community have access to 28 days supply. Where detained individuals are remaining in the UK the NHS England RECONNECT service will work to support the continuity of care to meet the health and social care needs of these individuals, where appropriate, mindful of the population and their experiences and working towards trauma informed engagement.
9. Input into the development of policy amongst the health, HO and justice partners and across government, to ensure that potential impacts from policy developments, including any expansion planning, has no detrimental impact on a detained individual’s health needs and their social care where required. Ensuring health protection of the population group via effective policy development. These issues must be collectively considered in planning and commissioning programmes with agreed, shared objectives (including commitment to fairness, diversity and equality of opportunity) that are mindful of the population and their experiences while maintaining an ambition to deliver system wide trauma informed services.
10. Improve the quality of data and intelligence collection and enable better data-sharing between partners. This includes improving the sharing of information during and after detention (where appropriate) to support continuity of care and to support the development of effective health outcome measures as well as including monitoring of post pandemic recovery as required.
How will we deliver
Our 10 priorities reflect the complex health needs of detainees and the dynamic immigration removal centre (IRC) environment. They are designed to:
- Support the delivery of the two core objectives.
- Meet the policy and strategic objectives of all partner organisations.
- Require collaborative action across organisations to ensure delivery.
We will work together to deliver activities and projects through our agreed work plan:
- Targeting our two core objectives
- Focus on our 10 priorities
- Delivered through a detailed annual workplan that outlines activities and projects and their associated deliverables, measures and timelines
- Feed into the detailed workplan for 2022-24 and Forward view 2022- 2023.
What we need to know
Improving our confidence in health data and how we measure success
The partnership recognises:
- The need for valid, reliable, timely and sensitive data to describe health needs among people in the immigration removal estate as well as the effectiveness of health service providers and health outcomes and how well services meet identified needs and the impact of policy decisions on health provision.
- Monitoring of health inequalities and access to comparator data where available to monitor trends.
- Improving health and wellbeing may be as much about changes to regime, staffing levels, food, accommodation, access to exercise, training, employment etc. as delivering specific health services. There is an inter-dependency of health and detention services.
- The requirement for a better understanding of cost and effectiveness across health and justice can improve performance.
- That measures of success will have to be described and reported against – by enhancing the immigration removal centre (IRC) health system (SystmOne) and the reporting dashboard. National performance management of achievements against the priorities will be delivered through the quarterly IRC Health Partnership Group as described through the work-stream updates.
The Health and Justice Data, Intelligence and Evidence Group (DEI) was established to provide strategic leadership and oversight to cross-organisational work on information, intelligence and evidence needs to support improvements in understanding of health needs and quality of health services delivered to people across the secure and immigration removal estate.
Who scrutinises what we deliver
Effective delivery of our objectives will be observed by existing scrutiny bodies.
National Audit Office and Treasury: The National Audit Office (NAO) scrutinises public spending for Parliament and is independent of government. The NAO and Treasury scrutinise and hold the Partnership to account for spending on healthcare delivered across the secure and immigration removal estate publishing public reports on their findings.
Care Quality Commission: An independent regulator of all health and social care services in England. The CQC ensures that services meet national standards of safety and care. It inspects healthcare across a number of settings which include IRC’s and STHF and social care services which are required to register with the commission.
Healthwatch: An independent consumer champion for health and social care across England, working to ensure consumer views are represented locally and nationally.
Independent Monitoring Board: Every IRC has an Independent Monitoring Board (IMB). Members are independent and unpaid, appointed by the Ministry of Justice to monitor the day-to-day life in their local immigration removal centre (as well as prisons and Young Offenders Institutes (YOIs)) and ensure that proper standards of care and decency are maintained.
Prison and Probation Ombudsman: The Prison and Probation (PPO) is appointed by the Secretary of State for Justice and investigates complaints from people held in the secure and immigration removal estate. The PPO is also responsible for investigating all deaths occurring within the secure and immigration removal estate producing Fatal Incident Reports. Has a duty under Article 2 European Convention on Human Rights (ECHR) to undertake an independent investigation into the care and treatment provided to those who die whilst they are detained in secure settings by the state.
Local Authority: Local Authorities can require relevant NHS bodies and health service providers to provide information and attend meetings to answer questions to enable the authority to discharge its scrutiny functions. There are no powers for local authorities to demand access to IRC’s or STHF’s.
Internal Organisational Governance: Partner organisations have in place internal (regional/national) governance to support NHS England quality standards through health provider contracts and collaborative commissioning.
HM Inspector of Prisons: An independent inspectorate which reports on conditions for, and treatment of, people in immigration removal centres as well as in prisons and YOI’s.
- Tony Eastaugh, Director General, Immigration Enforcement
- Matthew Style, Director General, Department of Health and Social Care
- Jenny Harries, Chief Executive Officer, UK Health and Security Agency
- Kate Davies CBE, National Director of Health and Justice, Armed Forces and Sexual Assault Services Commissioning, NHS England
Publication reference: PR1836