With sadness, we are alerting Medical Justice partners to the disturbing news that the Home Office has set out plans for changes to the Adults at Risk policy – to be re-named the ‘Assessing Detention for Vulnerable People policy’ to apply to anyone in detention, including children. 

The Home Office states the policy will be changed to an ‘evidence of needs’ model. The circumstances in which a Rule 35 report is to be completed will be greatly restricted compared to the current system, and the focus will be on managing needs in detention, rather than identifying those people who are at increased risk of harm in detention.  

Currently there are three circumstances in which rule 35 reports should be completed by the GP in the detention centre: 

Rule 35(1) reports should be completed regarding any detained person whose health is likely to be injuriously affected by continued detention 

Rule 35(2) reports should be completed in relation to any detained person suspected of having suicidal intentions 

Rule 35(3) reports should be completed in relation to any detained person where there are concerns that they may have been a victim of torture 

The completion of a rule 35 report triggers a review of detention and a written response from the Home Office. 

Under the Home Office’s proposed changes Rule 35 reports will only be completed if, in the immigration removal centre (IRC) doctor’s opinion, ‘a person’s needs may not be met in detention’. This applies a far higher threshold and encourages a “wait and see” approach leading to those at risk of harm in detention being left to deteriorate until such time as their needs become unmanageable in detention.  

It is particularly concerning to see the Home Office taking these steps to weaken safeguards, rather than address the significant concerns that have been repeatedly raised about the implementation of the current safeguards. 

Ongoing failings 

In December in AH and IS v Secretary of State for the Home Department [2025], a case brought by formerly detained men, IS, and Medical Justice client, AH, the High Court found that a key safeguarding mechanism for adults at risk in immigration detention had failed at the systems level, echoing warnings Medical Justice has issued to the Home Office for over 20 years. In her judgment  Mrs Justice Jefford ruled that there had in fact been a breach of the Article 3 ‘systems duty’ (the duty to take measures to protect people from the risk of torture or inhuman or degrading treatment) in relation to the operation of Detention Centre Rule 35 at Brook House IRC, at least between 28 July 2023 and 11 March 2024. Evidence from a medico-legal report by a Medical Justice psychiatrist was relied on for AH in the case. 

The case again demonstrated many of the issues Medical Justice has highlighted with the adults at risk policy and implementation of Rule 35 over many years, including the low number of Rule 35(1) and Rule 35(2) reports being completed and the disconnect between the ACDT process and Rule 35. 

The Assessment Care in Detention and Teamwork (ACDT) process is a custodial one used in IRCs, intended to reduce the risk of self-harm and/or suicide, involving regular reviews, with observations and/or periods of constant supervision carried out by detention custody officers. 

Both AH and IS had periods on ACDT and ‘constant supervision’ whilst detained at Brook House IRC, but neither had Rule 35(1) or (2) reports completed. In AH’s case a psychiatrist from Medical Justice visited him for assessment and wrote a letter raising concerns about his declining health and expressly recommending assessment for Rule 35(1) and Rule 35(2). No assessments or reports were completed following her recommendation.  

Numbers of Rule 35 (1) and (2) reports have been remarkably low for years across all IRCs, an issue highlighted by the Brook House Inquiry as well as frequently by HM Inspector of Prisons and Independent Monitoring Boards, and Medical Justice.  

In October the inquest into the death of Théophile Kaliviotis at Brook House IRC in 2024 will take place. The lawyer for his family argued at the pre-inquest hearing that he was ‘vulnerable and unwell’ and staff had failed to comply with Rule 35 in his case. 

At the inquest into the death of Frank Ospina who died by suicide in Colnbrook IRC in 2023, the Head of Healthcare said that if a Rule 35(2) had been done in the days preceding Frank’s death

“then we wouldn’t have had that outcome”. The inquest jury found that “the failure to submit a rule 35 report despite meeting the criteria deprived [Frank] of the opportunity of a detention review.” 

The low number of Rule 35 (2) reports highlighting suicidality is particularly stark when compared with the number of ACDTs opened and the number of people on constant supervision or ‘suicide-watch’. In AH and IS the judge referred to the disconnect that these statistics demonstrate in her judgment, stating:   

“The statistics as to the number of Rule 35(1) and (2) reports speak for themselves particularly when compared with the numbers of ACDTs and constant supervisions. It is inconceivable that if the system were operating effectively the numbers would be so low. […]  

The figures alone called for an answer but there had been no explanation for the figures other than a broad assertion that the system can be seen to be working. Nor has there been any or any satisfactory evidence that, between 2017 (the period covered by the [Brook House] Inquiry) and the period in issue in these cases, any effective steps were taken to address the failure in the system.  

The experiences of AH and IS are properly regarded as emblematic of this failure and the disconnected system and evidence that during the period with which these claims are concerned nothing has changed.”  

Medical Justice’s experience is that there has been no significant change since the period when AH and IS were detained, and we continue to see safeguards failing to protect vulnerable people who are at risk of harm in detention. 

Failure of implementation 

In AH and IS the judge also made the point that the failure to properly implement Rule 35 is not a matter of it being impossible, rather it is a matter of continuing failure by the Home Office to implement their own policy, stating

“there is a clear and persistent picture of a failure of the system intended to protect Article 3 rights of adults at risk…characterised by a failure to apply properly or at all the provisions of Rule 35”

and

“the failure is ensuring the implementation of the system and not in its design…the system was capable of working effectively but was not working effectively.” 

It is shocking that rather than addressing these persistent failures in implementation in order to improve protection of vulnerable people at risk in detention, the Home Office is instead planning to weaken the existing safeguards, especially so in light of its intention to expand the use of immigration detention and the recent re-opening of Campsfield IRC. This will inevitably lead to more vulnerable people being detained for longer periods, with an increased risk of harm, including harm that meets the threshold of inhuman and degrading treatment under Article 3. 

The Home Office should abandon these plans and instead take steps to ensure that existing safeguards are properly and effectively implemented, with a focus on preventing harm, rather than only responding once it has already occurred.