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Healthcare: Yarl’s Wood

Volume 604: debated on Wednesday 6 January 2016

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.”

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.

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.

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.

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?

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.

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.

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?

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.

Order. The debate must finish at 5.39 pm and I will be calling Front-Bench spokespeople at 5.19 pm, so speeches will have to be brief.

I congratulate the hon. Member for Edmonton (Kate Osamor) on securing this important debate. As a longer standing Member of the House, I pay tribute to all hon. Members who have tried so hard to shine a light on the difficulties. I want to mention in particular Sarah Teather, the former Member for Brent Central, who chaired a detention inquiry, on the panel of which I sat, to take evidence from those who had gone through the detention system in this country.

I think the public will be quite surprised by some of the facts that come out of this debate. Each year, some 2,000 asylum-seeking women are locked up in Yarl’s Wood. The majority of them are survivors of sexual violence and rape. Up to 93% of the women detained at Yarl’s Wood claim to have suffered sexual violence of some form, so these are the most vulnerable women that we can think of in circumstances that are far from ideal. Being locked up in detention exacerbates physical and mental health problems, so it is even more important that the health provision should be to a high standard.

Does my right hon. Friend agree that we should never forget that those who are detained have neither been accused nor convicted of any offence? It is therefore particularly important that they are afforded the high-quality healthcare to which those who have been convicted of no crime are entitled.

My hon. Friend makes a very important point. I just do not think that the bulk of people in our society have any idea that the UK is the only country in Europe with no time limit on immigration detention and that one can be detained for an indeterminate period without charge. Most people in British society would think that impossible, but we are the only country in Europe that currently does it. My hon. Friend is right that people who are detained indefinitely without charge should not be denied the healthcare they need. That is one of the key reasons why securing this debate was so important.

The detention inquiry that took place in the last Parliament made six important recommendations to Government, one of which I want to reiterate:

“Decisions to detain should be very rare and detention should be for the shortest possible time and only to effect removal.”

Those recommendations were made to the coalition Government and I sincerely hope that the present Government’s Minister will be able to say in his response what the Home Office is doing about those recommendations and the ones being made today.

We have heard about the types of health problems that women suffer from, but I will highlight the high percentage of suffering associated with sexual violence and the plight of pregnant women. Women for Refugee Women, an organisation already referred to, collected evidence from detainees in Yarl’s Wood and, frankly, as a mother it makes my hair stand on end. For example, a woman recently detained while pregnant said that she had only one hospital appointment while in Yarl’s Wood, which was for a scan at 20 weeks—as hon. Members know, that is late for a first scan. Even then she was escorted by officers who brought the lady to her appointment 40 minutes late. How anxious and frustrated she must have felt—even when she was brought to the necessary scan, she was not presented in time and was not able to speak to the midwife after the scan because no time was left. As a woman who has been through pregnancy, I would expect such basic healthcare provisions for people.

On the issue of pregnant women, the contrast is between the treatment available to women in my constituency at an award-winning midwifery unit and what women in detention get. Pregnant women in detention cannot even request access to a midwife—surely that has to be discussed further.

I could not agree more and that is why we are laying it on with a trowel today.

A further example from Women for Women Refugees distressed me greatly when I heard about it, just as the hon. Member for Edmonton was distressed by describing what women in detention have to go through. One woman had to wait three and a half hours for an ambulance while she was bleeding from a miscarriage. I suffered from multiple miscarriages and they can be a matter of life and death. If our constituents knew that a 999 call for someone suffering a miscarriage had taken three and a half hours to be responded to, they would soon be writing to the Secretary of State for Health.

We are at this debate to emphasise to the Government the urgency required to address the situation. What is it that deters the Home Office from taking a different approach to detention? In other countries, pregnant women or any of the people whom we would detain are detained in the community and kept at large there. Is the Home Office worried about the cost? I doubt it, because our system seems to be both expensive and unnecessary—holding someone in detention costs almost £40,000 a year and some of the detainees are held for a very long period. Community programmes are consistently found to be significantly cheaper. International evidence also demonstrates that such alternatives to detention support high levels of compliance. Perhaps the Home Office is worried about the risk of absconding? The Home Office is evaluating the UK’s new family returns process, which makes minimal use of detention, and the evidence is that there has been no rise in absconding since the introduction of the new community-orientated process.

I urge the Minister, when he responds to the debate, to address such urgent matters of basic rights. We should expect all UK citizens and guests in our country to be able to rely on such rights and on an emergency service and proper healthcare to a standard that we would all expect to be available when needed. As far as possible, we should move away from how so many women are being treated.

I pay tribute to my hon. Friend the Member for Edmonton (Kate Osamor) for securing the debate. For me, as for her and for the right hon. Member for Meriden (Mrs Spelman), this is a powerfully emotive subject. It is a debate about pride and shame.

I am proud to be the Member for Walthamstow. When I was elected, the then Member for Blackburn told me that there were two divides in the House: between left and right; and between those who have to deal with the UK Border Agency and those who do not. That was a pretty accurate description.

I am also proud to be a member of the Set Her Free campaign and to work with Women for Refugee Women—some of those women live in my community and I have been proud to campaign with them about Yarl’s Wood. Set Her Free is above all about giving voice, as my hon. Friend the Member for Edmonton did so eloquently, to those women detained at Yarl’s Wood now and whose voices we cannot hear unless others speak out for them. We are here today to speak out for those 2,000 women, the majority of whom we know to be the victims of rape and sexual torture and of persecution in their own countries. Yet when they come to our shores, this is how we treat them.

The healthcare problems are only the pinnacle of the injustice that Yarl’s Wood represents in our community. Many of the detainees have mental as well as physical healthcare problems: one in five has tried to kill themselves and 40% of them self-harm. Those figures come from the valiant work done by Women for Refugee Women to hold us to account for the existence of Yarl’s Wood. That work was cruelly disbelieved by the Home Office, so the report from Her Majesty’s inspectorate of prisons showing a tripling in the number of women self-harming in Yarl’s Wood should be testament to the work done by Women for Refugee Women to uncover just what the truth is about such a place in our society here in Britain in 2016.

My hon. Friend is making a passionate and excellent speech. Will she join me in underlining that when there is no statutory limit on the period of detention those mental health issues such as the self-harming become worse?

I am grateful to my hon. Friend for saying that, because she brings me to exactly what shames me. I feel shame about what is happening today in our country. I am ashamed that the UK is the only European country with no limit on detention, which absolutely compounds the mental health distress felt by many of those in Yarl’s Wood. I am ashamed that the HMIP report also reveals that male members of staff are supervising women on suicide watch—as Women for Refugee Women warned us was happening. What does that mean in layman’s terms? Vulnerable women are being watched as they sleep or as they use the lavatory. How is that happening in our country, on our shores?

I am also ashamed that all of that is futile, because two thirds of the women whom we lock up in Yarl’s Wood are then set free and, as Members have talked about, 90% of the pregnant women are set free. What is the point of putting them through that torture? I am ashamed, because it is not even value for money. As the right hon. Member for Meriden pointed out, it costs us £40,000 a year to hold those women in detention. We could find much cheaper, much more humane and much more dignified ways in which to manage our asylum system.

Above all, I am ashamed that we do not hear the voices of those women. I therefore want to read directly from their testament. The right hon. Member for Meriden cited a case, but I will read from the account of a woman who was not pregnant. The best way in which to guarantee the healthcare of women in Yarl’s Wood is to close the place down altogether. Let me read this out:

“When I came to England I was destitute, I was homeless. I went to Croydon to the Home Office to explain my situation. Before I could say anything, the lady said to me, you are lying. I said, God knows if I am lying…Then they took me to a room. Nobody told me they were taking me to detention. A lady said to me, they are taking you to another immigration office. They put me in handcuffs. I did not know what was going on. Since I was born I had never left my country before. They put me in the van and took me to Yarl’s Wood. They searched me. I wasn’t able to ask what was going on, because I was too scared of them. Nobody told me what was going on. They said, you are in fast track, but I didn’t know what that was.

While I was in detention, I was seriously sick, I was dying. My body collapsed. There were times when I could not walk. They took me to healthcare, they said you must eat, but I couldn’t eat the food. I was skinny, I was dying.”

This is 2016. We have had such debates for a number of years. It is not cost-effective, moral or effective in the modern world to have somewhere such as Yarl’s Wood in Britain. It should shame us all that it is happening on our shores. I ask the Minister, please, set her free.

It is a pleasure to serve under your chairmanship, Sir David. I congratulate hugely my hon. Friend the Member for Edmonton (Kate Osamor), because she has given those women a voice which, as my hon. Friend the Member for Walthamstow (Stella Creasy) said, is being denied them.

At the moment a great deal of attention is rightly being given to those who are crossing borders to seek safety. It is important that we focus our attention on those who reach the UK and seek our protection, and that we ensure they are treated with dignity and humanity. Every year, around 2,000 asylum-seeking women are locked up at Yarl’s Wood detention centre. Most are survivors of rape, sexual violence or torture. Because of their experiences in their countries of origin, those women are clearly vulnerable and many have serious physical and mental health problems. However, in spite of that, when they come to the UK for sanctuary they are locked up in detention, where they are re-traumatised, and the physical and mental health care available to them is wholly inadequate.

The chief inspector of prisons has called Yarl’s Wood a “place of national concern”. He found in his most recent inspection report that, of all the areas in the centre,

“healthcare had declined most severely”.

His report also pointed to the lack of gender-sensitive health practices in Yarl’s Wood. For instance, women who had newly arrived at the centre were expected to speak to male nurses as part of the health screening process and women who were placed on constant supervision, deemed to be so mentally distressed that they might kill themselves, were being watched by male staff in spite of their previous experiences of abuse and victimisation.

When Maimuna Jawo, who was detained in Yarl’s Wood prison, gave evidence to the parliamentary inquiry into the use of immigration detention, she said:

“Anybody who is on suicide watch has sexual harassment in Yarl’s Wood, because those male guards, they sit there watching you at night, sleeping and being naked.”

The Home Office has promised that a new policy will be put in place to ensure that women are watched only by female guards, but while the proportion of female staff at Yarl’s Wood remains under 50% there are serious questions about whether such a policy will ever become practice.

There are also real concerns about the treatment of pregnant women in detention, as hon. Members have said. Research by Medical Justice found that pregnant women miss antenatal appointments and some do not have any scans while detained. The poor care provided to those women is particularly troubling when we consider that, as has been said, for most of them detention serves absolutely no purpose.

I want to highlight one important point: staff from Yarl’s Wood were actually prosecuted for offences against detainees. It is important to place that on the record.

I am grateful that the right hon. Lady placed that on the record. It turns my stomach that we are in this situation. Ninety of the 99 pregnant women detained in Yarl’s Wood in 2014 were released back into the community to continue with their cases, so they were locked up and re-traumatised for no reason at all. One of the pregnant women who the charity Women for Refugee Women is in touch with, a survivor of trafficking, was recently released back into the community after being detained for almost two months, even though Home Office guidance says that pregnant women should be detained only if their removal is imminent.

I am sorry to interrupt the hon. Lady’s excellent speech, but do we not have to be a tiny bit careful about making the point that people are sometimes released into the community and then continue normally? It happens in the criminal system that people who are remanded in custody subsequently have their trial and are acquitted, but that does not necessarily mean that, in all cases, there is not a public policy reason for such action. I understand her argument, but I wonder whether that is the strongest point.

I will come on to strengthen my point in a moment. It is welcome news that the Home Office has committed to consult on its policy of detaining pregnant women and I hope that it will engage with a wide range of stakeholders, including women who have been in detention while pregnant, to make sure that the process is meaningful. Standards of healthcare in Yarl’s Wood need to improve as a matter of real urgency, but we must not lose sight of the fact that locking up women who have come to the UK to seek our protection is harmful by its nature. However much healthcare services are improved, detention causes mental health trauma and exacerbates physical problems.

These women do not need to be in Yarl’s Wood in the first place. Their claims could be dealt with much more effectively in the community. In fact, two thirds of asylum-seeking women are released from Yarl’s Wood to do just that. The Home Office’s own evidence on the new family returns process found no rise in absconding among families seeking asylum since children stopped being detained at Yarl’s Wood. We can and should learn from that.

Minister, locking up women seeking asylum is expensive, unnecessary and unjust. It is time that the practice is swiftly brought to an end.

I congratulate the hon. Member for Edmonton (Kate Osamor) on her heartfelt, moving speech. I want to thank her for crying—I am not the only one who does that in this place. She said that she wanted to be the voice for women detained in Yarl’s Wood and she has been that incredibly well today. Her demonstration of how deeply she feels will matter to them when they watch the debate.

If the UK Government need more evidence of the desperate human consequences of unlimited incarceration of vulnerable people, the shameful reports of inadequate healthcare as well as the dire treatment of female detainees in Yarl’s Wood should be telling enough for them to abandon their inhumane policies. I appeal to the Minister, who I know has a humane side to him—sometimes a very humane side—to do something now. We are waiting on the outcome of reports, but we already have significant reports, so we should not wait for more of them before we do anything.

Yarl’s Wood is a prison for people who have committed no crime, as the hon. Member for Cheltenham (Alex Chalk) pointed out, where diabolical health and safety standards threaten the lives of innocent people, many of whom have already been victims of torture and trauma. Evidence of the degrading, inhumane consequences of indefinite detention shows the vital need for time-limited detention as a matter of urgency. The Scottish National party has long supported that. The UK Government are fundamentally failing to protect some of the most vulnerable women seeking refuge.

Yarl’s Wood fails to meet the most basic standards of health and safety for detainees and is a “place of national concern”. Those are not my words, but those of the chief inspector of prisons, Nick Hardwick. I sincerely hope that the Government will listen to that and do something as a matter of urgency.

I want to return to something that the hon. Member for Edmonton talked about. Last year, 90 of the 99 pregnant women detained were later released and not deported. I think it was the hon. Member for Rotherham (Sarah Champion) and the hon. Member for—[Interruption.] She and the hon. Member for Walthamstow (Stella Creasy)—I do that in every debate—asked, if 90 of those women were later allowed to go to homes in the UK, what were they doing there in the first place? The hon. Member for Bishop’s Stortford—

The constituency names do not come up on the Annunciator in Westminster Hall. In an equally moving speech, the right hon. Member for Meriden (Mrs Spelman) noted that in 2015 there were—I think she said—only two pregnant women in Yarl’s Wood. I would be interested to hear from the Minister whether that is because the Government are now politically opposed to the detention of pregnant women and whether we can expect that number to go down rather than up.

I also pay tribute to the right hon. Lady for speaking movingly about how deeply she feels about the situation, and in particular for mentioning her experience of miscarriage. That is not an easy thing to do, but she recognised her duty to do that to highlight the problems faced by other women.

I share the shame that the hon. Member for Walthamstow mentioned she feels. She did something important: she spoke in this place the words of women currently in detention. The hon. Member for Rotherham—I know where she represents—has been a true champion of those seeking asylum. She rightly questioned why 90 pregnant women were at Yarl’s Wood in the first place if they were released.

The SNP has long called for an end to the unlimited detention—imprisonment, in fact—of migrants. It recently advocated that a 28-day maximum time limit be written into the Immigration Bill, based on evidence that being locked up for any longer would be catastrophic for the detainees’ health. An unlimited period of detention not only causes damage to health, but is a fundamentally unnecessary and expensive exercise.

My hon. Friend the Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald), who is our immigration spokesperson, asked a parliamentary question in September about the cost per capita of detaining someone in one of these centres. The reply from the Home Office was that last year the average cost to hold an individual in detention was £91 per day. I would argue, as others have, that that money could be better spent elsewhere. The Home Office has also said that the UK detains immigrants only as a last resort, but in 2013 it detained just over 30,000. Germany detained just over 4,000, Belgium just over 6,000 and Sweden almost 3,000. During that time, Germany received four times as many asylum applications as the UK, and I do not think anyone would accuse Germany of being a soft touch. We are the only EU country to have no time limit on detention.

Many of the women detained at Yarl’s Wood have backgrounds that include trafficking and torture, as well as physical and mental abuse. A young woman who fled persecution in Uganda on account of her sexuality talked about the lack of support for those with mental health problems and how the lack of appropriate healthcare in the detention centre led to suicidal thoughts. I understand that some counselling services were withdrawn last year; will the Minister give us an update on that? Surely that was a mistake and those services will be reinstated, because if anywhere needs it, it is that place. We must address the failures not only in Yarl’s Wood but in the immigration system as a whole. We cannot put up with a prison-like system, not only because of the financial consequences, but because of the devastating human cost, which is simply not just.

I pay tribute to a choir that came to this place from Manchester at Christmas. In fact, they might have sung in this Chamber. They are called WAST—Women Asylum Seekers Together—and it was incredibly moving to witness them just before Christmas. All the women had been in detention and were now out, but the damage that had been done to them, by not only the detention but whatever had happened in their past, was visible.

I conclude by repeating something I have said on more than one occasion in this place. I know that we no longer detain children, but I am going to use the words of a 10-year-old boy who I knew extremely well. He was in Yarl’s Wood with his mother and could stand it no longer, and said to her, “Mummy, please can we just die? Please, dying would be better than this. Let us die.” That child was 10 years old. It does not matter what age someone is; if we are doing something to people that makes them feel like they want to die, we have to do something about it. We cannot keep waiting for report after report after report. Listen to the reports that have come out already and take action as soon as possible.

It is a pleasure to serve under your chairmanship, Sir David. I, too, pay tribute to my hon. Friend the Member for Edmonton (Kate Osamor) for securing this debate and for her powerful and insightful comments. I am grateful for all the powerful and insightful comments that have been made this afternoon. It is a shame there are not more men in the room. This is a question not of women’s issues but of human rights, and it is notable that there are not as many male Members present as there should be—this is not a party political point—both to contribute and to hear the contributions that have been made.

Of course, immigration rules have to be enforced and, in exceptional circumstances, detention is necessary, but it must always be humane and done to the highest standards, and there must always be safeguards. The point has already been made that, in relation to this particular type of detention, where there has been no conviction—no wrongdoing—it is particularly important that the detention service’s operating standards are kept to, and that the same range and quality of healthcare services is provided in detention centres as is available on the NHS. That point was made early in the debate, and it is central to this issue, because it is manifestly not the case in Yarl’s Wood.

There is clear evidence of repeated failures in relation to the rule 35 reports, in relation to the treatment and detention of pregnant women and the mentally ill, and in the provision of adequate healthcare more generally. Such repeated failings, and the reports on them, bring into question whether Yarl’s Wood is still fit for purpose. That is the central question. But, instead of taking action, the Government repeatedly refer us back to reports that are due out, such as the Shaw review into the welfare of vulnerable people in detention. That review is important, but it has been with the Minister for some time now—I think it was completed in the autumn—so, in the light of the concerns that have been raised on many occasions and again in this debate, will he tell us when it will be published so that we can see its findings?

The rule 35 reports are central to the provision of care, welfare and healthcare in Yarl’s Wood. They are intended to be a report of any case where continued detention is likely to injure the detainee’s health, so they are central. They are sent, or are supposed to be sent, to the Home Secretary, who must consider and respond to them. As has already been mentioned, the quality of the rule 35 reports in Yarl’s Wood, these central reports that are supposed to flag up cases so that something can be done about them, is appalling.

Although part of it has already been read out, it is worth giving in full the quote from the 2015 report by the chief inspector of prisons, which said that the rule 35 reports

“were among the worst we have seen. All were handwritten and many were difficult to read, lacked detail and were perfunctory. Some responses were dismissive.”

That shows a manifest failing of a flagging system that is supposed to start the process and alert the Home Office to concerns so that something can be done. How can the rule 35 reports examined in the 2015 report be among the worst that have ever been seen?

It is clear that the Home Office’s response to these reports has also been inadequate on occasion. A recent example is the case of a Sudanese refugee that went to the High Court. In that case, the medical practitioner at Yarl’s Wood had filed a rule 35 report, which gave details of previous injuries caused by beatings with metal rods, knife wounds and even a gunshot. Despite the evidence of torture, the Home Secretary said that there were exceptional circumstances justifying detention. The High Court disagreed, finding that the woman had been wrongfully detained and calling the case “truly disgraceful”. What is the point of the rule 35 procedure if adequate responses are not made in every case?

A further problem that has already been touched on is the detention of pregnant women and the mentally ill. It may be that the number is coming down, but it is a very serious issue. There have been far too many in the past, and any detention of anyone who is pregnant requires exceptional justification. There is no evidence that those exceptional circumstances are made out in so many of these cases. As the director of midwifery at the Royal College of Midwives, Louise Silverton, has said:

“Some pregnant women have reported receiving inadequate healthcare, which clearly puts their unborn baby at risk as well.”

The law is designed to protect pregnant women and those with other vulnerabilities from being detained. It is not being applied properly, it has not been applied properly in the past, and that now raises the question of whether, if it cannot be applied properly, it should be applied at all. There are other provisions in relation to vulnerable individuals.

I am aware of the time, but I want to mention one other issue, which I think has already been raised: the investigations into the deaths in custody that have occurred in the past few years. In particular, there have been reports of the death of a 40-year-old female detainee in March last year in which it has been said that the detainee was denied medical assistance. I know that there has been an investigation, so could the Minister give us an update on that and tell us when we can see its findings? That might tell us so much more about the provision of healthcare in Yarl’s Wood.

To conclude, it is not acceptable to wait for yet more evidence and yet more reports before something is done about the appalling situation in Yarl’s Wood. Now is the time for action. Frankly, if the rules cannot be applied properly in Yarl’s Wood and adequate medical provision cannot be made to safeguard the health and welfare of some of the most vulnerable people in our society, the question is whether Yarl’s Wood is fit for purpose.

It is a pleasure to serve under your chairmanship, Sir David. May I congratulate the hon. Member for Edmonton (Kate Osamor) at the outset on securing this debate and on her contribution? I know that she feels strongly about this subject and has been committed to it over a period of time and since she has been in the House. I know how deeply she feels about these issues, as her contribution showed. I am genuinely grateful for the manner in which she has approached this debate.

As the hon. Lady indicated, one of the first things I did following the general election and my reappointment as the Immigration Minister was to visit Yarl’s Wood, recognising a number of the issues raised about the centre, and I specifically visited the healthcare centre at that time. I can certainly assure her and other Members of our focus on this issue and, indeed, the importance that the Home Secretary and I attach to the dignity and welfare of those in detention. That is of the utmost importance, and we take those responsibilities extremely seriously. I hope to talk about some of the generalities of the policy, to focus on Yarl’s Wood specifically and to address rule 35 access to independent medical examinations, as well as some of the other points flagged up, in the time available to me.

Our policy is that vulnerable people should not normally be detained under immigration powers. Our processes are designed generally to prevent vulnerable individuals from being detained unless there are very exceptional circumstances and, when vulnerability emerges after the point of initial detention, we aim to act quickly and appropriately.

Reference has been made to the Shaw review. Indeed, the hon. and learned Member for Holborn and St Pancras (Keir Starmer) highlighted it in his contribution. The Home Secretary commissioned Stephen Shaw to carry out an independent review of welfare in detention—that is, in immigration removal centres, in short-term holding facilities and for detainees under escort. The review considered many of the issues discussed in today’s debate. Mr Shaw was asked to look at current systems and policies, including those in place for identifying vulnerability, managing both the mental and physical health of detainees, providing welfare support, preventing self-harm and self-inflicted death, assessing risk, managing food and fluid refusal, and safeguarding. We have received Mr Shaw’s report and, as I indicated on Report of the Immigration Bill, it is our intention to publish both the report and our response to it before Committee consideration of the Bill in the House of Lords. That remains our intention.

I was just about to address the detention issues raised by the hon. Lady, as well as those raised by the hon. Member for Rotherham (Sarah Champion). The hon. Member for Walthamstow (Stella Creasy) referred to fast track in her contribution. I underline that I made the decision to suspend detained fast track—in other words, where an asylum case is being considered—because I was not satisfied with the safeguarding provisions around vulnerability. I will reintroduce it only when I am satisfied that appropriate processes and procedures are in place to ensure its safe reintroduction.

Will the Minister confirm whether, when the Government respond to the Shaw report, there will be clarity as to whether they consider women who are victims of rape and sexual torture—that is, two thirds of the residents of Yarl’s Wood—to be vulnerable in and of themselves, and therefore inappropriate for detention?

I will be careful not to pre-empt the Government’s response, but the hon. Lady will not have long to wait for the Shaw report. I recognise the importance attached to it. Indeed, the Home Secretary commissioned the report because of the importance we attach to it. My comments today will be based on the position as it stands, but the Government will have more to say on these issues shortly.

I speak as the MP for the constituency where Dungavel is based, and also as a psychologist. When I visited that centre, it struck me that another issue of vulnerability for individuals who have suffered abuse and trauma is being detained alongside foreign national offenders who may be violent or sexual offenders. Will the Minister comment on how such risks are assessed, particularly given that it was pointed out to me that prison records do not always follow foreign national offenders into the units?

I assure the hon. Lady that risk assessment takes place. There is sometimes a mix of different people within an immigration removal centre: some of them will be foreign national offenders, and others will be there as a consequence of the removal process. It is worth underlining that we are talking about immigration removal centres. The primary purpose is the removal of people from this country, but there will be public protection issues, and risk assessment is clearly a core part of the operation of any immigration removal centre.

I am conscious that I now have four minutes left to respond to the various points made, so I will try to make as much haste as I can. Several Members mentioned indefinite detention. It is not possible to detain under immigration powers indefinitely. There are significant, long-standing and, we believe, appropriate protections against the arbitrary use of administrative detention by the state in this country.

I say to my right hon. Friend the Member for Meriden (Mrs Spelman) and other Members that we are carefully considering alternative options to detention. Our published policy is clear that alternatives to detention should be used wherever possible. As I indicated on Report of the Immigration Bill, we are considering the overall issues of the detention estate more broadly and are examining alternatives as part of that ongoing work. Members referred to the family removals process.

I will make some progress, as I now have three minutes remaining.

On the specific complaints issues raised, our detention centre rules are designed to ensure that female detainees’ rights, dignity and privacy are upheld. Should we receive complaints that contractors are breaching those rules, I assure hon. Members that such cases will be investigated fully and firmly.

On the issue of female members of staff and the availability of care and support, nurses are available 24/7 in Yarl’s Wood but, as in the community, they will not always be female. Detainees have the right to request to be seen by a female doctor or nurse, which will be arranged wherever possible. Midwives from Bedford Hospital NHS Trust visit the centre once a week, and the frequency and length of attendance is determined by demand.

The hon. Member for Edmonton mentioned independent medical examinations. Detention centre rules require that a registered medical practitioner selected by or on behalf of a detainee is given reasonable facilities for examining detainees. IRC suppliers rightly take requests very seriously and seek to accommodate them in accordance with the rules, but I am aware that some groups have made representations and expressed concerns. We are examining those closely and considering this issue carefully. I assure the hon. Lady that I recognise that issue, and we are examining how best to address it.

The Home Office will be revising the template form that IRC doctors are required to use when completing rule 35 reports, in order to make it clearer what information the Home Office requires of doctors when they complete such reports. We have consulted on the proposed changes with the relevant stakeholders. The intention is to make the forms easier for doctors to use, thereby improving the content of rule 35 reports. That is an important aspect, in order to ensure we act on those reports and consider them appropriately.

On the CQC report, an action plan is very much in place, and I have had discussions with NHS England about that. It is being worked through, and we take these issues very seriously.

I am grateful to the hon. Member for Edmonton for the constructive discussion today. I confirm the importance we attach to this issue and, if I may, I will seek to write to her on the other issues that time has unfortunately prevented me from addressing.

Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).