The Brook House Inquiry: Medical Abuse in…

The Brook House Inquiry ran from 2019 to 2023 including hearings from November 2021 to April 2022. The Inquiry concerns the inhuman and degrading treatment of immigration detainees at Brook House Immigration Removal Centre following the undercover reporting by Panorama, which exposed the abuse. One issue for investigation for the Inquiry was the role of medical services in causing or contributing to the article 3 ECHR mistreatment by failing to ensure that torture survivors, mentally ill people, suicidal people and other vulnerable detainees were not properly identified and released, or even managed in detention.

What was uncovered at Brook House may be of wider significance to detention settings across the UK because many of the key individuals concerned are involved in the provision of services to other detention centres and prisons. Issues arising include allegations of systemic failings, breach of professional clinical standards and breach of patient confidentiality. I acted for a number of core participants in the Inquiry and acted earlier in judicial review proceedings that caused the inquiry to be held. I set out a summary of the conclusions from the report of the Inquiry after some remarks on the evidence.

The Background

Torture, inhuman and degrading treatment have long been prohibited by the common law and since 2000, article 3 to Schedule 1 to the Human Rights Act 1998 has provided that:

“No one shall be subjected to torture or to inhuman or degrading treatment or punishment”.

According to the case law, where such mistreatment does occur, it must be investigated, the full facts must be brought to light and lessons must be learned so that it never happens again. There have been six cases in the High Court or Court of Appeal in which conditions in immigration detention have led to findings of mistreatment contrary to article 3. The earlier cases led the government in 2016 to ask Stephen Shaw to make recommendations to address the findings of the High Court. Despite those recommendations, in 2017, Panorama was able to uncover significant continuing abuse and neglect. The lawyers of one of the detainees subjected to the article 3 mistreatment therefore asked that there be an investigation. The Home Office refused to hold a public inquiry, but ultimately it was forced to hold a public inquiry with powers to compel witnesses and with funding for representatives following the judgment of May J in R (MA and BB) v SSHD [2019] EWHC 1523 (Admin) who held that the investigative duty under article 3 required it.

It is well established, including in evidence to the Inquiry, that immigration detention can have a negative impact upon a detainee’s mental health and that impact increases the longer that person is in detention, particularly where, as with immigration detention, there is no fixed time limit on the duration of detention. The causes of mental deterioration resulting from detention itself include not just the length of detention, but also pre-existing trauma such as torture or other forms of ill-treatment. When, in the early part of the century the Labour Government hugely expanded the numbers of immigrants detained, it made clear it expected to see rigorous and robust enforcement of the safeguards in policy and practice, as well as the highest standards of governance, oversight, management and vigilance in ensuring compliance. The evidence heard in the Inquiry so far, however, points to exactly the opposite at all levels within both the Home Office and G4S.

The key safeguards are to be found in Rules 34 and 35 of the Detention Centre Rules 2001 and the Adults At Risk policy. Their combined effect should provide a procedure for the mental and physical examination of a detainee within 24 hours of their entry to an IRC and to secure the prompt reporting of key indicators of vulnerability: principally a risk of injury to health through continued detention, suicidal ideation and a history of torture. The purpose of these safeguards is to secure prompt release of those whose vulnerability means they should not be detained.

Medical Evidence

The Inquiry heard from a wide range of witnesses including from four nurses and two doctors who worked in the detention centre. Links to the evidence are included below.

The purpose of immigration detention is notionally to enforce removals (although the evidence is that most people who are detained are later released without being removed from the UK). For anyone wanting to understand the force and degradation involved in the process of removing an apparently mentally ill person with what the Home Office found to be a lawful use of force, the full process is shown in video of Day 14 starting at 5:00:40.

On Day 29, 11 March 2022 the Inquiry heard from Dr Oozeerally who still runs the medical services in Brook House. As the Inquiry report explains (vol 1, p. 156) “under questioning by Counsel to the Inquiry, Dr Oozeerally accepted that it would never be in the interests of a patient to have force used against them, except in the very limited circumstances of acting to save their life, if it was in imminent danger). Yet in one case examined by the Inquiry Dr Oozeerally had written a note stating he was happy for force to be used on a man who had undergone triple bypass surgery. Dr Oozeerally (and his partner Dr Chaudhary) gave remarkable evidence admitting to never once (in nine years of work) having complied with his statutory duty under rule 35(2) of the Detention Centre Rules to report to the Manager on a detainee whom he suspected of having suicidal intentions. In fact, Dr Oozeerally did not even know who the Manager to whom he was legally obliged to report was. It was an admission made all the more extraordinary by Dr Oozeerally’s attempt to justify his conduct in this respect and in numerous others. It merits watching for anyone interested in the challenges of maintaining ethical and competent practices in detention environments. The Chair concluded “Dr Oozeerally was unapologetic about his failure to fulfil his obligations under Rule 35, and he was intransigent in his view that Part C forms were an effective method of securing a Home Office review of detention, He did not demonstrate insight into his actions and omissions. Upon publication of this Report, a copy will be provided to the General Medical Council.” Dr Oozeerally continues to my knowledge to run the medical services at Brook House and at many other detention centres in spite of the report of the Inquiry.

Three nurses gave candid evidence of how the system, which, as explained above, is designed to protect vulnerable people from being subjected to detention that could re-traumatise them, was neither properly implemented nor even understood in Brook House IRC. In particular, the evidence of Sandra Calver on Day 21 (1 March 2022), who was expertly questioned by Sarah Simcock, counsel to the inquiry, merits watching for a deeper understanding of the problems that have been encountered in relation to medical care in detention settings. Two other nurses gave similar evidence (Karen Churcher and Chrissie Williams on Day 28).

The other nurse giving evidence on 14 March was Jo Buss who has now been struck off the register. She had previously admitted all the charges against her concerning her involvement in an incident in which a detainee known as D1527 was abused by detention centre officers in her presence (as shown on Panorama) and in which she appeared to agree not to write up the abuse as a “use of force” incident. Buss made an attempt in evidence to retract her admissions.

The Inquiry has also heard from experts and concerned citizens who have devoted themselves to the improvement of conditions and the ending of abuse of detainees in immigration detention. Theresa Schleicher of Medical Justice and Dr Bingham appeared on 14 March 2022 giving (in my view) a well-informed assessment of what they described as the failure of the Home Office and its subcontractors to abide by their legal obligations under rules 33-35 of the Detention Centre Rules 2001. The inquiry also heard extensive evidence from Professor Bosworth; Dr Hard; Dr Collier and others.

The Chair’s Findings

The Chair of the Brook House Inquiry was tasked with examining allegations of inhuman and degrading treatment within a snapshot period of five months during 2017. The Chair explicitly rejected the analysis as presented by the Home Office and G4S at the inquiry that the findings of extensive violence, inhuman and degrading treatment was the consequence of the actions of a small number of people as opposed to a symptom of systemic failure. The following are the key findings:

The Chair found that there were 19 incidents- at least one a week- amounting to inhuman or degrading treatment. These incidents included considerable violence, humiliation and degradation of detainees. The scale of likely abuse is only apparent when one considers that these findings were made as a result of examining the experience of 13 different detainees. In the five-month period in question around 3,000 people were detained there. Most of those detained were never reached by the Inquiry: they had been removed, returned to their home countries, or moved on.
The Chair found that “the entire safeguarding system in a number of areas to be dysfunctional” (Report para 40, page 9). The law and practice around removal from association was “routinely misunderstood, misinterpreted and misapplied by both G4S and the Home Office” and she found that “this confusion and potential misunderstanding persists under Serco” (para 38, page 9 and Vol II, page 347 para 36). Misuses of segregation were a matter of serious concern (para 38, p.9). There were 241 cases of isolation (removal from association under rule 40) in the five-month period under examination (Vol II page 346, para 34). The Chair found that in at least 237 of those cases, the use of isolation was not properly authorised. She found that the confusion appears to be continuing under Serco.
There was a misuse of force against 11 of the 13 detainees whose cases were examined in detail and pain was deliberately and unnecessarily inflicted on four of them during the inappropriate use of force (page 4, para 15.2). Force was misused against naked people (para 43, p.10): 3 of the 13 detainees were forcibly removed from their cells while naked or near naked (page 4, para 15.2). Force was misused against mentally ill detainees (see Vol. II, page 155). Monitoring and oversight was inadequate and led to dangerous situations (Vol II. Page 158). Misuse of force included the choking incident on D1527 that featured in Panorama. Shocking footage extending to 28 minutes was seen by the inquiry. The use of restraint techniques such as handcuffing behind the back that were found in the Mubenga Inquest to be dangerous (2010) continue to be used.
The Chair found “serious failings in the application of rule 34 and 35” (para 32, page 8) which amounted to a wholesale failure in processes designed to protect vulnerable detainees like suicidal people and torture victims from being detained, or from mistreatment while in detention, particularly in relation to suicidal people. She found healthcare did not understand their obligations towards detained individuals and failed to appreciate their key safeguarding role (para 50, p.11). Vol II page 343, para 29 “This safeguard was not operating effectively at the outset of detention in 2017 and evidence indicated that this remained the case at the time of the Inquiry’s hearings”. Para 33 “The inquiry has not received any evidence of fundamental changes since 2017”.
The Chair found “explicit racism” (Vol II, page 227. Para 41) and “found considerable evidence of racist beliefs and abuse by staff at Brook House” ((para 89, page 243) She found that “Brook House appears to have been a breeding ground for racist views in the relevant period and was perceived as an acceptable environment in which to express them”. See also para 55, p.12. The Chair was “Particularly concerned by the lack of reflection by some of those who remain working in Brook House, a number of whom are now in more senior roles. It inevitably casts doubt on how far the cultural changes described by Serco can be said to have been embedded. There is more to do”. The Chair found a culture of dehumanisation, of “us and them” (Vol II page 229).
There are relentless accounts of racist; homophobic and other degrading language. (para 15.8- homophobic). In many cases such language was intensified during times when detainees were self-harming or attempting suicide.
Lengthy lock-ins detrimental to mental and physical well-being were driven by financial incentives connected to lower staffing levels (para 30 page 7).
The prime responsibility lay with the Home Office and its contractor G4S, yet there was alarming reliance on monitoring by volunteers at the Independent Monitoring Board. The Home Office accepted it did not sufficiently resource staff to monitor its contract (para 21 page 5). Her findings closely mirrored those of previous investigations: the problems have persisted for many years and continue.

The Chair made one principal recommendation of significance which is that there should be a maximum period of immigration detention of 28 days to bring the UK within comparable norms for civilised countries.

Conclusions

Having been privileged to have worked on this case with estimable colleagues for more than six years, I would make these final observations on the process. The evidence of mistreatment in this inquiry is extensive. The findings of the inquiry reflect little credit on Detention Centre Officers, detention centre medics, detention centre managers, the private contractors, various bodies charged with oversight, the Home Office or on our Ministers. All of these people were paid public money to perform roles in which they were responsible for the welfare of a vulnerable group of people. With the exception of Detention Centre Officer Callum Tulley, none of these individuals or organisations exposed what was going on. Even when faced with video evidence of inhuman and degrading treatment, the Home Office did not want the inquiry to happen. It fought tooth and nail to resist the judicial review by which it was ultimately compelled to hold the inquiry. However, in the end, the Home Office did comply with its legal obligation to ensure that its own failings were brought to light and examined. In the end, it allowed an opportunity to put its own failings right. It is a sign of a civilised society that this inquiry has taken place and brought into the open on what the Chair called the “hidden places” of our society. The scrupulous devotion of the inquiry team in bringing the hidden places into view should be acknowledged. This work is a crucial part of a society based on the rule of law.

There remains the task of ensuring that lessons are learned and this never happens again. Wholesale reforms are required. As yet there is, regrettably, little sign of that being done voluntarily. Most of those singled out for criticism remain in post. G4S and the Home Office are yet to even apologise to the detainees for the abuse the detainees suffered. A copy of the Report has been sent to the Home Affairs Select Committee and the Joint Committee on Human Rights so that, in due course, implementation of or compliance with the Inquiry’s recommendations will be regularly monitored and reported upon.

Alex Goodman KC and Stephanie Harrison KC have also recorded a podcast about the inquiry.

Alex Goodman KC practises in public law and is the winner of the Outstanding Achievement Award at the Legal Aid Lawyer of the Year 2021.