Prescribed places of detention, in England, include prisons, immigration removal centres, the children and young people's secure estate, young offender institutions, secure training centres and secure children's homes. Among the vulnerable groups in prisons and places of detention are asylum seekers, pregnant women, children, the elderly, people with a learning disability, and those with a physical disability or mental health problems. People in detention can also be vulnerable from the perspective of ethnicity, religion or their political affiliation. They can present with a number of complex needs, and may have specific vulnerabilities that are the result of past traumatic experiences (British Medical Association (BMA), 2020).
These issues that detainees face have been exacerbated by COVID-19. Guidance has been issued by the Ministry of Justice and the UK Health Security Agency (2021) that aims to assist custodial, detention and healthcare staff in addressing COVID-19 in this population.
The Health and Social Care Act 2012 introduced changes to the way the NHS in England is organised and how the commissioning of health services provided for those living in the community, as well as people in a detained setting, is organised. Those who are detained are entitled to the same range and quality of healthcare services as the general public receives in the community. However, problems associated with the provision of health care in detention exist, especially concerning the range and quality of services and staffing levels (BMA, 2020).
Immigration detention relates to the detention of migrants and asylum seekers for administrative purposes, usually to determine their identity, process their claim or, where applications have been rejected, to detain the person until their removal from the UK. The number of people who entered detention in the year ending March 2020 was 23 075—5% less than the previous year (Home Office, 2020).
Services offered in places of detention have to be equally accessible to all, acknowledging that certain vulnerable groups may have greater needs.
Women in detention have specific health issues and healthcare needs. Often, however, places of detention and their regimes are generally designed by men and for men, with many places of detention run by men. In the UK, women make up less than 10% of the prison population. This often means that any healthcare arrangements are more than likely to prioritise the needs of men, neglecting those of women. Women detainees can be left vulnerable. The United Nations Rules for the Treatment of Women Prisoners (2010) include provisions to ensure that the specific healthcare needs of women are met.
Women in detention, for example, may require special consideration because they are menstruating, pregnant or breastfeeding. Women should be provided with unrestricted access to free-of-charge sanitary items. Antenatal, postnatal and gynaecological care should be made available.
A health needs assessment, a systematic method for reviewing the health issues facing a population, should be undertaken and regularly reviewed. This can lead to agreed priorities and resource allocation, with the potential of enhancing a population's health and wellbeing and to also reduce inequalities.
There are a range of challenges for nurses and other healthcare workers working in detention settings. They are required to meet the needs of the people to whom they offer care and support, often in environments that make this a challenge. Commissioners of health services in prescribed places of detention should provide education and training along with continued support in health and wellbeing issues for nurses and other care providers who are working with detained individuals.