In the custody cell, safeguarding and health care

Indicators

• Cells and communal areas are clean, free from potential ligature points and graffiti, of a suitable temperature and well ventilated, with access to natural light. Staff carry out daily cell checks to maintain these standards and records are maintained and monitored.
• All cells are equipped with working call bell systems that cannot be permanently muted. Staff explain to detainees how to use the call bell and activations are responded to promptly.
• There are adequate arrangements in place for daily cleaning, removing any biological hazards, regular deep cleaning, and prompt repair of any defects.
• There are working fire alarms throughout custody. Staff can safely evacuate the custody area in the event of an emergency and evacuations are regularly practised and recorded.

Indicators

• All staff are trained in and use effective de-escalation techniques.
• Where force is used, staff only use approved techniques in line with their training, with no more force and for no longer than is strictly necessary and proportionate.
• Staff can demonstrate awareness of risks associated with particular forms of restraint and of how these risks can be minimised. When force is used detainees are examined by an appropriately qualified health care professional if requested, or if there are health care concerns.
• Detainees in need of mental health care who are restrained for their own or others’ safety are treated as a medical emergency.
• Only age-appropriate and approved restraint techniques are used for children. When force is used, children are always examined promptly by an appropriately qualified health care professional.
• Use of force prior to arrival and within custody suites, including the use of control and restraint equipment, is documented within the individual custody record and a separate ‘use of force’ form is submitted.
• Strip-searching is conducted only when absolutely necessary. It is appropriately authorised with a written record of the justification and authorisation. It is carried out in private by members of staff of the same gender (in the presence of an appropriate adult if required), and is monitored at a senior level to ensure appropriate use.
• No child is subject to a strip search unless it is intelligence led, authorised by a senior officer and conducted in the presence of an appropriate adult.

Indicators

• Detainees are offered sufficient, and varied nutritious food and drink in accordance with their dietary requirements.
• Detainees are able to shower/wash and suitable alternative clothing, including underwear, is available to them.
• Detainees are routinely provided with a clean mattress, pillow and blanket.
• Detainees are offered outside exercise.
• Detainees are routinely offered suitable activities, including reading materials.
• When under surveillance, detainees are able to use the toilet with decency and dignity and toilet paper is readily available.
• Children and other vulnerable detainees are provided with the opportunity to have visits by family members and/or appropriate agencies that can provide support.

Indicators

• Custody staff are trained in safeguarding and have the knowledge required to protect vulnerable groups in their care, including arrangements for contacting appropriate adults and making suitable referrals to partner agencies.
• Current government and local guidance about safeguarding children and adults is accessible and safeguarding procedures are known and used by all staff.
• Those responsible for the welfare of detained children are informed of a child’s detention in custody and the grounds for detention at the earliest opportunity.
• Children are kept safe in custody and separate from those who might pose a risk to them. Where it is appropriate to do so, children are not held in cells.

Indicators

• The parents or guardians of those under 18 are used whenever they are willing, able and suitable for the role of appropriate adult. They are given written guidance on the role and are encouraged to actively protect the child’s rights.
• The regions work actively with local partners to ensure the provision of independent, effective and suitably vetted appropriate adults for children and vulnerable adults.
• There are no delays in securing an appropriate adult and they are available 24 hours a day.
• Adequate facilities are available to ensure that appropriate adults can speak to children or vulnerable adults in private and to remain with them if the appropriate adult considers this is necessary to ensure their welfare.
• The central custody directorate collects data in relation to the provision of appropriate adults including those who performed the role (for example, parents/guardians and social workers). The data includes waiting times and which aspects of the process they were present for, and is collated and analysed to assess whether the service is meeting the needs of children and vulnerable adults.

Indicators

• Children are diverted from custody where possible.
• Staff understand and respond to the distinct needs of children. They recognise levels of maturity and how physical, sexual and emotional abuse and exploitation might affect a child’s behaviour and any subsequent decisions taken about their care and welfare.
• Risk assessments are based on all relevant information. Particular attention is given to recognised risks associated with: looked-after children; disabilities, including intellectual impairment (learning disabilities), communication difficulties, health conditions and substance misuse; a previous history of abuse; those in custody for the first time; child sexual exploitation; human trafficking.
• Children are kept safe in custody and separate from those who might pose a risk to them. Where it is appropriate to do so children are not held in cells and are offered age-appropriate suitable activities.
• Children are returned home to their parent/guardian. Where this is not possible and/or there are safeguarding concerns, there are effective arrangements with the local authority that cover the provision of accessible safe accommodation for children.
• Girls under the age of 18 are allocated and informed of the identity of a named female officer who is responsible for meeting their welfare needs while detained in custody.
• Custody officers actively seek to minimise the time children spend in custody and if investigations cannot be progressed they promptly consider alternatives to custody.

Indicators

• The requirement for health services for detainees in Border Force custody is assessed and the services provided are appropriate to need.
• Accountability and contract monitoring arrangements consider the impact any breaches of performance have on detainee health outcomes.
• Clinical governance arrangements are robust and effective, including partnership working between Border Force and health providers, incident management, information sharing, a confidential health complaints process, monitoring of response times for all health services and patient outcomes and processes to improve provision based on lessons learned.
• Detainees are treated by health care practitioners who receive ongoing training, supervision and support to maintain their professional registration and development.
• Health care practitioners have the skills, knowledge and competences to meet the health care needs of all detainees.
• Health care practitioners are sensitive to detainees’ situations and diverse needs and have access to professional interpretation services.
• Information sharing protocols exist with appropriate agencies to ensure efficient and confidential sharing of relevant health and social care information.
• Clinical examinations are conducted confidentially unless risk assessment suggests otherwise.
• Clinical rooms provide conditions that maintain decency, privacy and dignity.
• Clinical facilities are fit for purpose and meet required infection prevention and control standards.
• Providers of health services have registered with the relevant regulatory authorities as required.
• All first aid equipment (including the resuscitation kit) is appropriate, ready for use and regularly checked and maintained, and staff understand how to access and use the equipment effectively.

Indicators

• All detainees who are held in Border Force custody are seen promptly by a health care practitioner.
• Arrangements to gain and review patient consent are appropriate. When patients lack mental capacity to make a decision, health professionals make ‘best interests’ decisions in accordance with legislation.
• Interventions are appropriate to the clinical needs of the detainee and are in line with national guidance.
• Detainees can see a health care practitioner of the gender of their choice on request. There are arrangements for a chaperone to be present if required.
• Health professionals monitor patients for adverse effects on health and well-being linked to prolonged detention in custody, and implement appropriate plans of care to counteract this.
• Each patient has a single clinical record which meets contemporary record-keeping and storage standards.
• Information is shared within the bounds of medical confidentiality to promote continuity of care and maintain patient safety.
• Health care professionals liaise with other agencies, as necessary, to ensure continuity of care.

Indicators

• Detainees are prescribed and receive medication promptly.
• Detainees are, where indicated, monitored for signs of withdrawal, receive medication to provide relief for drug and alcohol withdrawal symptoms if clinically indicated, and can continue community prescribed opiate substitution treatment in custody, subject to validation.
• Detainees who smoke have prompt access to nicotine replacement treatment.
• Medications are administered at clinically appropriate times by competent staff and appropriate records are made.
• All medications (including detainees’ own) are stored safely and securely, and are disposed of safely if not consumed. There is safe pharmaceutical stock management and use.
• Detainees who are due prescribed medication and are being transferred to court custody receive their medication and have safe access to adequate ongoing treatment while at court.

Indicators

• Border Force officers and staff receive regular training on mental health, personality disorders and learning disability issues, including identification of such issues and how to support detainees who are experiencing problems.
• All staff involved in the care of detainees, including health professionals, are cognisant of the potential adverse impact of prolonged detention in custody on mental health and well-being and take appropriate action to mitigate this.
• There is a clear mental health referral pathway that ensures prompt assessment, appropriate support and continuity of care during detention in custody and on release.
• Detainees who require assessment or treatment under the Mental Health Act are assessed and transferred promptly.