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.  

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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. 

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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.  

This week a judicial review brought by trafficking survivors detained under the ‘one-in one-out’ UK-France scheme is being heard. The survivors are challenging the blocking of modern slavery appeals and the case touches on barriers to disclosure faced by trafficking survivors which have been documented by the Detention Taskforce, a consortium of expert organisations chaired by Medical Justice. 

Government ministers insist that “late” or “last-minute” modern slavery claims are being used to frustrate deportation attempts. This narrative, which is being used to justify changes to modern slavery laws, fails to acknowledge the significant barriers that stand in the way of survivors disclosing their trafficking history at the earliest opportunity while held in immigration detention. Treating “late” disclosures as less credible shows a lack of understanding of the impact of trauma on people who have been trafficked. 

In its March 2026 briefing “Barriers to Disclosure: A survivor of trafficking’s journey through the immigration process”, the Detention Taskforce charts the barriers to disclosure that survivors recently detained for removal to France at every stage in their journey face through the immigration process – from their arrival in the UK by small boat and often bewildering screening interview to their arrival and induction at an immigration removal centre. Drawing on Taskforce members’ experience, including Medical Justice’s recent research, the briefing identifies challenges with healthcare screening and clinical safeguards as well as access to legal advice, which are all exacerbated by the nature of the UK-France immigration decision process that is accelerated by design. 

The briefing also highlights our serious concerns about the September 2025 change to the Modern Slavery Statutory Guidance which removes some people’s right to have a negative decision reconsidered, including those detained for removal under the UK-France deal. This policy change, which has been implemented inconsistently so far with some people receiving a reconsideration and others being refused it, is being challenged in the High Court this week by six trafficking survivors who were detained under the UK-France deal and whose reconsideration requests were refused. As barrister Sam Grodzinski KC told the court: “Victim identification is a process that takes time; it can’t be done speedily, not if it is to be done properly.”

Read the full briefing here

The Detention Taskforce on survivors of trafficking in immigration detention works to build a better system for survivors of trafficking in immigration detention, and ensure no victim of trafficking is further harmed by detention. Chaired by Medical Justice, the Taskforce is comprised of 18 expert organisations working with, or for, victims or survivors of trafficking. 

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Medical Justice is recruiting for a new Head of Clinical Evidence & Casework, a senior leadership role that manages a team of caseworkers and clinicians to develop high quality medical evidence and support vulnerable people detained in immigration detention.

About the role

Casework is at the heart of everything Medical Justice does. We assist vulnerable people mistreated in immigration detention and the medical evidence we produce forms the basis of our advocacy work to secure lasting change. As Head of Clinical Evidence & Casework, you will play a key role in strengthening and developing our ability to reach more people in detention. Leading a team of caseworkers, employed and volunteer clinicians and interpreters, you will oversee the development of high-quality medical evidence, facilitate access to healthcare for people in detention, and collaborate closely with our Advocacy team and external organisations to challenge and end medical mistreatment in immigration detention.

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Head of Clinical Evidence & Casework

Salary: £47,500 – £51,500 per year with cost-of-living adjustments (if relevant) three times a year plus an annual increase of £500 for 5 years and 5% pension contribution.

Reports to: The Director

Working hours: Full time (37.5 hours per week). Flexible working patterns can be considered.

Office: North London, near Finsbury Park, with some flexibility for remote working.

Contract Type: Permanent

Terms: 28 days holiday per year, plus statutory bank holidays, plus 2 Wellbeing days

Benefits: Include sick pay from day one, enhanced parental leave, one-to-one counselling sessions and group reflective sessions with a psychologist, ‘cycle to work scheme’, weekly staff lunch, flexible working considered.

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Informal online information sessions

We are holding informal online information sessions to learn more about the role and Medical Justice on:

• Monday 22 December at 12:30
• Friday 9 January at 13:00

Email recruitment@medicaljustice.org.uk to sign up.

Closing date

Tuesday 20 January 2026, 23:30

Further information

Further information about the role is included the this candidate pack and once you are ready, apply via CharityJobs

 

 

With MPs and Peers back in Westminster after their summer recess, we share some updates below about Medical Justice’s work in Parliament this year, and what’s coming up.

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All Party Parliamentary Group (APPG) on Immigration Detention

The APPG on Immigration Detention is a cross-party group of MPs and peers that advocates for evidence-based reforms to immigration detention policy, and the welfare of detained people. Medical Justice was instrumental in setting up the group in 2019 and has acted as its secretariat since then.

Following last year’s general election, Medical Justice helped to re-establish the APPG with Labour’s Bell Ribeiro-Addy MP elected as the group’s Chair. So far this year the group has delivered a number of high-profile activities – you can read more about each below.

 

Meeting with Dame Angela Eagle DBE MP, Minister for Border Security and Asylum (March 2025)

The APPG met with Dame Angela Eagle on 12 March 2025 in the House of Commons. The meeting was attended by the Minister, Bell Ribeiro-Addy MP, Baroness Lister of Burtersett, Baroness Ludford, and Elspeth Macdonald from the Secretariat, and Home Office officials.

APPG members raised issues of interest and concern, including the Home Office’s plans to expand the detention estate, alternatives to detention, implementation of the Brook House Inquiry’s recommendations, and detention-related aspects of the Border Security, Asylum and Immigration Bill 2025.

During the discussion the Minister indicated her willingness to continue engaging with the APPG, and this is something the groups plans to pursue with her successor Alex Norris MP.

 

Panel discussion on the current state of immigration detention in the UK (March 2025)

The APPG’s panel discussion took place on 20 March, and looked at the current state of immigration detention in the UK and its impacts on detained people.

APPG Chair and speakers at panel event on 20 March 2025

Click here to access a full summary of the meeting, including Q&As

 

Speakers included Joel Mordi, a Nigerian LGBTQI+ and human rights activist currently working with Rainbow Migration on their  No Pride in Detention campaign. Mr Mordi was previously detained at Harmondsworth Immigration Removal Centre (IRC) and spoke about the devastating and lasting impacts that detention can have on those subjected to it, including members of the LGBTQI+ community. Mr Mordi’s speech is available in full on the APPG’s website.

Charlie Taylor, HM Chief Inspector of Prisons and Dr Hindpal Singh Bhui OBE, Inspection Team Leader at HM Inspectorate of Prisons  also spoke. In 2024, Mr Taylor warned of a “worrying deterioration in safety” across UK IRCs, with an inspection of Harmondsworth IRC finding “the worst” conditions inspectors had ever seen in UK immigration detention, and serious concerns likewise reported at Brook House IRC. Mr Taylor and Dr Singh Bhui discussed these findings in more detail. They also provided an update from a recent visit to Harmondsworth where, despite good progress in some areas, a number of key concerns remain, in particular in relation to the safeguarding of vulnerable people.

Over 40 guests attended the event including parliamentarians, people with lived experience of immigration detention, and representatives from the Royal College of Nursing, the Independent Monitoring Boards, and front-line immigration and asylum charities.

 

Visit to Harmondsworth IRC (July 2025)

The APPG conducted a visit to Harmondsworth IRC on 24 July, attended by Bell Ribeiro Addy MP and Baroness Lister of Burtersett (pictured below).

Prompted by HMIP’s report on the IRC in 2024 (see above), the visit was an opportunity to better understand how the Home Office and current contractor Mitie have responded to the Chief Inspector’s findings. Central to the visit was a meeting with men currently held at the site who shared valuable insights about their ongoing experience of being detained at Harmondsworth and current conditions.

Prior to the visit, both the Chair and Baroness Lister also met with Bail for Immigration Detainees, JRS UK, and Medical Justice and were briefed on the organisations’ current key concerns regarding the facility.

The APPG plans to continue its engagement with Home Office and contractors, including following up on issues raised during the visit, in the coming months.

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Border Security, Asylum and Immigration Bill 2025

The Border Security, Asylum and Immigration Bill was introduced in Parliament in January 2025, with the stated aim to “improve UK border security and to strengthen the asylum and immigration system”. You can read more about the Bill and the planned changes it will (and won’t) make to detention here.

As the Bill made its way through the House of Commons earlier this year, Medical Justice shared its concerns about the draft legislation and how it needs to be changed in a number of parliamentary briefings and evidence submissions.

The Bill now being looked at by the House of Lords, and Medical Justice has continued to highlight its damaging effects and advocate for key changes. This has included producing a number of briefings as part of the Coalition for Asylum Rights and Justice (CARJ):

• Joint briefing for Lords Second Reading – CARJ, including Medical Justice
• Joint briefing for Lords Committee Stage – CARJ, including Medical Justice

We have also joined calls for the introduction of a time limit on immigration detention. Medical Justice remains firm in its view that the use of immigration detention must be ended, given the known harm it inflicts on those subjected to it. We see the introduction of a time limit, which has been backed by the UK Parliament’s Home Affairs Committee and Joint Committee on Human Rights, HM Chief Inspector of Prisons, the British Medical Council and the Brook House Inquiry amongst others, as an important interim step towards achieving that ultimate goal.

An amendment to the Bill introducing such a time limit was tabled by Liberal Democrat peer and APPG members Lord German, supported by Labour’s Baroness Lister of Burtersett and the Lord Bishop of Chelmsford. Jointly with other NGOs, Medical Justice produced a detailed briefing about the amendment and why it is needed:

• Joint briefing on detention time limit amendment – Detention Action, Bail for Immigration Detention, ILPA and Medical Justice.

The amendment was debated in the Lords on 3 September 2025. In his speech, which you can watch here or read in full, Lord German said:

“I tabled this amendment because….I believe that it is a change that needs to happen. When I visited an immigration removal centre last year and spoke to detainees and staff, it was made clear to me that case progression for immigration detainees is slow and hampered by staff shortages. Further to this, detainees were unaware of the progress on their cases and when they could expect to leave detention or be removed. Communication to them was minimal and this clearly led to despair and frustration with the lack of hope for the future.”

While the Home Office Minister Lord Hanson’s response made clear that the government does not intend to support such a change, Medical Justice will continue to keep working with MPs, peers and NGO colleagues to make the case for a 28-day time limit wherever possible in Parliament and more widely.

Medical Justice collates Home Office Immigration Detention statistics through regular Freedom of Information requests. These statistics have now been updated to the end of December 2024.  

The statistics cover the following thematic areas: 

• Rule 35 reports 

• Self-harm incidents and Assessment Care and Detention Teamwork (ACDT) 

• Segregation 

• Use of Force  

• Comparison between numbers of Rule 35 reports and those on ACDT, including constant supervision  

The statistics are available here.  

The top-line statistics for 2024 show that: 

• 74 Rule 35 (1) reports, 35 Rule 35 (2) reports and 2,473 Rule 35 (3) reports were completed for people in detention. 

• There were 715 Use of Force incidents at Brook House Immigration Removal Centre (IRC), 188 at Colnbrook IRC, 43 at Derwentside IRC, 34 at Dungavel IRC, 156 at Harmondsworth IRC, 76 at Tinsley House IRC and 151 at Yarl’s Wood IRC. 

• 1292 ACDTs and 419 constant supervision ACDTs were opened. 

• At least 1,340 people were held in segregation under Rule 40 and at least 25 under Rule 42. 

• While 1292 ACDTs and 419 constant supervision ACDTs were opened in 2024, only 74 Rule 35 (1) reports and 35 Rule 35 (2) reports were completed in detention. This shows that high numbers of individuals have been identified as warranting observation for suicide or self-harm risk, but in all but a few cases, the clinical assessment and reporting process for risk of deterioration and risk of suicide has not been followed.  

For Medical Justice’s analysis of the Home Office statistics for 2024, as well as our own statistics based on our 2024 clients, please see our latest report: Medical Justice Annual Review: The state of healthcare and harm in UK immigration detention in 2024. 

If you do use this resource, please credit Medical Justice as the source. We also would appreciate it if you could let us know when you use this resource, so we are able to keep track of how widely and well-used it is. Please email our researcher, Ariel, to let her know if you use this resource and also if you have any questions a.plotkin@medicaljustice.org.uk.   

Read the Annual Report here

 

The Medical Justice Financial Year ending 31st January 2025 Annual Report shows how we changed lives and made detention less harmful. Thank you for making it possible. You can download the report here.

In 2024, inspectors warned of the worst conditions they have ever found in immigration removal centres (IRCs) where detained people continue to be at imminent risk.

20,604 men, women and children were held in detention in 2024. The situation remains urgent – this report details how Medical Justice continues to evidence the severe harm caused to detained clients by the catastrophic failures in safeguards that have led to inhuman and degrading treatment.

In 2024, rather than change direction and strengthen safeguards, the new Labour government continued the previous government’s moves to weaken safeguards and to expand detention, in full knowledge of the severe harm this risks – harm that cannot be described as accidental.

Changing lives

• 508 referrals for detained people in 2024 – some say we changed the course of their lives.
• 90% of a set of 73 clients assessed by Medical Justice clinicians and received a medio-legal report were released.

Secured systemic lasting change making detention less harmful for thousands of people

• Released: research report “You’ll see the outside when you’re in Rwanda” – analysis of harm caused to 48 clients detained for removal to Rwanda. 82% were torture survivors. 78% had suicidal thoughts. All 48 were released.
• Established: duty to consult Medical Justice on detention policies affecting vulnerable people – our successful litigation means the Home Office must engage constructively with us, and receive our evidence and suggestions for improvements, which, if adopted, potentially benefit thousands of detained people.
• Secured: improvements to clinical safeguards for thousands of detained people each year – including Home Office Rule 35 training for IRC clinicians, NHS England guidance on Rule 35 safeguarding reports and Adults at Risk Statutory Guidance.
• Galvanised: Medical Justice evidence quoted by the Royal College of Psychiatrists – our research, analysis and case-studies used in the report “Protecting the mental health of people seeking sanctuary in the UK’s evolving legislative landscape”, covered by the British Medical Journal and galvanising the medical community.

 

Clearly these achievements in FY2025 are stepping stones. Our ultimate vision is that immigration detention is unable to harm anybody’s physical or mental health as it no longer exists in the UK. Certainly, this is a long-term endeavour, and it cannot come about without the stepping stones we are laying down now.

One of the most significant systems changes to make the immigration and asylum system more humane is to end the mistreatment of people held indefinitely in immigration detention. That is unlikely to happen without medical evidence of the harm. Medical Justice is the only source of such medical evidence as it is the only charity to send clinicians to see detained people in all the UK’s IRCs, to document the harm they suffer, to analyse and to present the evidence in a digested format to use in our own advocacy work for system change and by like-minded groups. Medical Justice is recognised as the UK’s expert on deterioration of detained people’s health, with extensive and uncontested evidence of how and why dysfunctional clinical safeguards severely harm detained people.

Medical Justice is a critical actor in the required collaboration of organisations and voices. In 2024, we galvanised the influential voice of the medical community and primed parliamentarians to act by bringing them together with experts, lawyers, detention monitoring bodies, and people with lived experience through the All-Party Parliamentary Group (APPG) on Immigration Detention for which we act as the secretariat.

We thank all our partners, clients and funders for their invaluable support.

Medical Justice welcomes the Supreme Court’s decision to refuse the Home Office permission to appeal a ruling that its failure to consult with Medical Justice on changes to guidance for immigration detention caseworkers was unlawful.

 

 

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Our judicial review challenged the Home Office’s ‘Second Opinion’ policy which allows it to disregard a medico-legal report from Medical Justice for a detained client while it seeks a second opinion from a doctor it contracts.  There is no requirement for the Home Office doctor to ever actually meet the detained person or have any expertise in documenting deterioration of health in detention. In one case a second opinion report took weeks to be produced, during which time a detained person could deteriorate further in detention.

In January 2024 the High Court found that there had been an unlawful failure by the Home Office to consult Medical Justice regarding changes to its Adults at Risk Caseworker Guidance which lays out the Second Opinion policy. The Home Office appealed and in March 2025 the Court of Appeal upheld the High Court’s decision. The Home Office sought to appeal to the Supreme Court which was refused permission on 4^th July 2025.

In most cases, the Home Office does consult NGOs on immigration detention policies, and when it does, Medical Justice has sometimes been able to secure improvements to policies, making them less harmful for thousands of detained people. The Home Office failed to consult on the Second Opinion policy (other than with their own contractors) and that closed the door to the possibility of improvements before it started having an impact on detained people.

This is an important victory for Medical Justice – we want to work constructively with the Home Office to improve policies for people held in detention, and for the Home Office to pay full attention to our expert evidence and analysis based on our clinical assessments of those who have already been severely harmed by its policies.

The courts, inquiries and inspection bodies have repeatedly found that vulnerable people have been subjected to inhuman and degrading treatment in UK immigration detention. The Home Office should be welcoming our input, not shutting the door on policy consultation.

Now the Home Office must consult us on its Adults at Risk policy, the door to policy improvements is permanently wedged open, potentially benefitting many thousands of detained people. Our lawyer said

“I am not aware of another NGO succeeding in a judicial review in establishing a duty to consult … certainly in the context of the immigration system. It is at least very rare, if not unique.”

We thank our very able lawyers – Jed Pennington at Wilsons who instructed Shu Shin Luh and Laura Profumo, who were led in the Court of Appeal and Supreme Court by Angus McCullough KC.

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Seeking a strategic thinker with strong operational management experience who is absolutely passionate about challenging injustice to strengthen our vibrant and highly respected organisation.

As the first Head of Operations, you will provide strategic oversight, work with staff to translate our strategy into actionable, measurable plans for efficient and effective work, which will enhance the impact for people in immigration detention.  Your management of the team’s operations will support our growth, resilience, and sustainability.

Download the Application Pack.

 

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Head of Operations

Salary: £39,000 to £42,000  with an annual increase of £500 each year for 5 years and 5% pension contribution

Reports to: The Director

Working hours: Full-time. Flexible work patterns can be considered

Where based: At the Medical Justice office near Finsbury Park, London with some flexibility for remote working

Length of contract: Permanent

Terms: 28 days per annum holiday, plus statutory bank holidays, plus 2 Wellbeing days

Benefits: Include ; sick pay from day one, enhanced parental leave, one-to-one counselling sessions and group reflective sessions with a psychologist, ‘cycle to work scheme’, weekly staff lunch, flexible working

 

What they say about Medical Justice;

“What Medical Justice did was absolutely remarkable. They sent two specialists to see me in Harmondsworth and they did the most amazingly thorough job documenting all my scars. Then I got my medico-legal report which was over 40 pages long. They did thorough, professional work – there is nothing more that they could have done and ultimately this work got me out of detention.” – former detained person and Medical Justice client

“[Medical Justice] has strong characteristics and a highly respected reputation. It is regarded as principled, expert and evidence-based, tenacious in its casework and policy work, fierce and ferocious when needed and brave in the way it speaks truth to power.” – fellow non-governmental organisation

“Medical Justice has an outsized impact for its size – it is highly effective and the team is absolutely terrific, which is all the more impressive in the difficult political context.” – Medical Justice funder

 

Informal online information sessions

Additional information session this Friday 13th June 1-2pm

An opportunity to ask questions about Medical Justice and its work as well as about the Head of Operations role. Please email Lisa Incledon on l.incledon@medicaljustice.org.uk if you would like to participate in an information session.

Closing date

9am Wednesday 18th June 2025

Further information

Please see the APPLICATION PACK.

Medical Justice establishes the right to be consulted by the Home Office on its ‘Adults at Risk’ policies.

The Court of Appeal has upheld a successful judicial review brought by Medical Justice that – based on its consistent practice of consultation – the Home Office has a duty to consult Medical Justice before introducing policy relating to the immigration detention of ‘adults at risk’.

A Medical Justice spokesperson said : “This is a vital curb on the Home Office bringing in ever more injurious detention policies that cause severe harm to those it detains indefinitely.

Over the years there have been some important modifications to Home Office policy following consultation with Medical Justice, resulting in lessening the harmfulness of some policies – that door must not be closed off.  We are delighted that the duty to consult Medical Justice has been established – it is a momentous win in the fight for the rights of people held in immigration detention ; the door to policy improvements is now wedged open.

This constraint on the Home Office has never been more needed ; the Brook House Inquiry revealed an alarming and continuing level of inhuman and degrading conditions in immigration detention and the Home Office has since weakened rather than strengthened safeguards designed to protect vulnerable people in detention. Furthermore,  despite knowing the severe harmfulness, the government has announced a significant expansion of detention, meaning the harm cannot be described as accidental.”

Medical Justice is extremely grateful for skilled representation by Wilson Solicitors partner Jed Pennington, Angus McCullough KC (1 Crown Office Row), and Shu Shin Luh and Laura Profumo (Doughty Street Chambers).

For more details about the case, please see the below, based on a note kindly written by Medical Justice’s legal team.

 

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In a decision handed down on 14^th March 2025, the Court of Appeal has upheld a judicial review brought by Medical Justice that the Home Office is required to consult it before introducing any policy affecting the immigration detention of ‘adults at risk’. The Home Office acted unlawfully in failing to do so in respect of a policy which allowed for second medical opinions to be sought from Home Office contracted doctors when presented with medico-legal reports commissioned by or on behalf of people in immigration detention (‘the Second Opinion policy’). The Court of Appeal’s judgment (available here) confirms the importance of the consultation duty as a cornerstone of democratic governance, particularly in the context of the exercise of immigration detention powers.

Background and what the Court of Appeal decided

For more background about the case, you can read the Wilsons Solicitors’ post on the High Court judgment here.

In summary, the High Court’s 12 January 2024 judgment found that the Home Office had a duty to consult Medical Justice, a key stakeholder, on policies affecting the detention under immigration powers of vulnerable people, and that the Home Secretary acted in breach of that important duty by failing to do so during the formulation of and prior to implementation of the Second Opinion policy. The High Court also quashed the Second Opinion policy on the basis it contradicted the Adults at Risk Statutory Guidance that was issued under section 59 of the Immigration Act 2016. The High Court decided that the Statutory Guidance only allows for a very short (“de minimis”) period for the Home Office to seek further evidence when it received a medico-legal report by or on behalf of a detained person who claims to be an adult at risk, and does not allow the Home Office to prolong detention just to seek a second medical opinion.

Following the High Court’s decision, the Home Secretary conducted a consultation involving Medical Justice. Following this, the Adults at Risk Statutory Guidance was amended to more explicitly allow for its Second Opinion policy and revised non-statutory guidance was published, which came into effect on 21 May 2024.

Notwithstanding the fact that the policies under scrutiny by the High Court had been superseded by revised versions, the Home Secretary appealed the High Court’s judgment.

On the duty to consult, the Home Secretary asserted that: “When, and whether, ad hoc engagement with interested individuals and organisations gives rise to current and prospective legal obligations to consult is of pressing concern across central and local government”.

The Court of Appeal dismissed the Home Secretary’s appeal on this ground outright, finding that there was no error in the carefully considered analysis of the High Court which led to a finding that the Home Secretary has a duty to consult Medical Justice on detention policies affecting adults at risk, and its failure to do so in respect of the Second Opinion policy was unlawful.

Success on the consultation point is important for Medical Justice and other organisations that engage with the Home Office as. the duty of consultation underpins a democratic process where the risk of injustice being done to the affected groups is minimised by hearing from representative bodies able to voice concerns and proposals on their behalf. Past consultations with Medical Justice on adults at risk immigration detention policies had resulted in a material difference to the form and substance of the policy subsequently implemented.

In respect of the construction of the Statutory Guidance, the Court of Appeal allowed the Home Secretary’s appeal on a narrow basis, finding that the Guidance allowed for a “short” time period for the Home Office to seek further evidence. It did not, however, provide guidance on how long this might be and did not decide whether the timescales provided for in the Second Opinion policy were lawful. What is “short” and “reasonable” will depend on the circumstances of the individual case.

The Court of Appeal acknowledged that the Statutory Guidance and Second Opinion Policy considered by the High Court had been superseded by revised version of the policies, but accepted the Home Secretary’s submissions that it is possible that there will be claims for damages for unlawful detention in relation to people who had the Second Opinion policy applied to them before the amended policies came into effect on 21 May 2024. There was no evidence that there were any such claims but given the 6-year time limit for bringing false imprisonment claims, this remains a theoretical possibility.

Finally, the Court of Appeal made an order upholding the declaration made by the High Court that there had been an unlawful failure to consult Medical Justice and refusing the Home Secretary’s application for permission to appeal to the Supreme Court.

What the Court of Appeal did not decide

First, Medical Justice’s original grounds had argued Statutory Guidance issued under section 59 of the 2016 Act must further the statutory purpose of this provision by facilitating the prompt identification of adults at risk, their release, and the reduction generally in the detention of people vulnerable to harm in immigration detention. However, the High Court decided that the narrow purpose of section 59 was to ensure Parliamentary oversight of the Statutory Guidance. If guidance (statutory or non-statutory) is issued which cuts across the intention of Parliament in passing section 59, it may be open to challenge on the basis of Medical Justice’s argument.

Second, the principle underlying the High Court’s decision that non-statutory guidance will be unlawful if it contradicts statutory guidance still holds good. This was not challenged by the Home Secretary. The Court of Appeal’s judgment was decided on the narrow basis that the Statutory Guidance did permit a “short” time for obtaining further evidence, but went no further to find whether the timescales in the Second Opinion Policy reflected this or contradicted this principle.

Third, the Court of Appeal’s judgment does not close off claims for damages for people subject to the Second Opinion policy. In relation to people detained under the policy that was in place before 21 May 2024, and the one that came into effect on this date, it will be open to argue that the timescales for seeking second opinion evidence were unreasonable and therefore unlawful in their individual case. Relevant factors affecting the legality of detention may include the assessment of the likelihood of harm and the seriousness of harm of remaining in detention, as well as the risks of absconding and offending if the person is released.

Further information

The ‘adults at risk’ policy was introduced by the Home Office in response to Stephen Shaw’s report, which the Home Office commissioned due to concerns that too many vulnerable people were being held in immigration detention, for too long. This had led to a number of court cases where people in immigration detention were subjected to conditions that were inhuman and degrading. The Brook House inquiry also made findings that people at Brook House immigration removal centre were held in conditions that were inhuman and degrading.

In addition to its concern at the policy being introduced without any form of consultation, Medical Justice brought this challenge due to concerns around the Second Opinion policy causing immense suffering and harm to people who are particularly vulnerable people in immigration detention. Through its casework, Medical Justice has already seen vulnerable people deteriorate during the period of delay caused by the application of the Second Opinion policy. The important context for the rise in external medico-legal reports that led the Home Office to introduce the Second Opinion policy is the long-standing systemic failures in the safeguards in the immigration detention system, the Rule 35 process and associated policies.

Notes

A bundle of key documents from the case is available here, including the judicial review grounds, the key witness statements for the consultation point, and the decisions on its Costs Capping Order.

On 2 December 2024, parliamentarians held a meeting to re-establish the All-Party Parliamentary Group (APPG) on Immigration Detention.  

Following a vote by the membership, Bell Ribeiro-Addy MP (Labour) was elected as the APPG’s new Chair, and Rt Hon. the Lord Garnier KC (Conservative), Baroness Hamwee (Liberal Democrat) and Mohammad Yasin MP as its officers. Medical Justice was re-elected as the APPG’s secretariat. 

 

APPG meeting attendees (L-R): Lord German (Liberal Democrat), Baroness Bennett of Manor Castle (Green Party), Baroness Lister of Burtersett (Labour), newly elected APPG Chair Bell Ribeiro-Addy MP (Labour) and Rt Hon. John McDonnell MP (Labour). 

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First launched in 2019, the APPG – which temporarily ceased to exist in May due to the general election – brings together more than 25 parliamentarians from across the political spectrum who share concerns about the use of immigration detention in the UK. It works to raise awareness within Parliament about immigration detention and its impacts, and to offer a forum for MPs and Peers to debate with subject experts, including those with lived experience of detention. Using information gathered through its activities, the APPG advocates for evidence-based reforms to immigration detention policy and for the welfare of detained people. 

With a recent increase in the number of people being detained, a significant expansion of detention planned, and deeply concerning conditions reported at Brook House IRC and Harmondsworth IRC amongst others, it is vital that the use of immigration detention by the new government continues to be carefully scrutinised in Parliament. The  APPG will make an important contribution to this. 

Membership of the APPG is open to MPs and peers of any party. If you cannot see your MP on the APPG’s current members list, please considering writing to them and asking them to join. They can do so by emailing contact@appgdetention.org.uk.  

Enter your postcode here to find your local MP and their contact details. 

You can stay up-to-date with the APPG’s ongoing work by following it on X/Twitter.