Originally due to end today, 11 June 2026, the UK-France ‘one in, one out’ pilot has been extended until October 2026 despite overwhelming evidence of the harm it is causing. The scheme treats displaced people as bargaining chips – for each person removed to France, another person in France can apply for asylum in the UK.

High levels of vulnerability and extensive evidence of harm

The high levels of vulnerability among, and the harms caused to, people detained under the scheme have been comprehensively documented by Medical Justice clinicians and our casework team. Medical Justice reviewed the cases of 20 of our clients who had a medico-legal report from our independent clinicians and published our findings in Politics over people?. All 20 had clinical evidence of a history of torture, ill-treatment and/or trafficking. All 20 had serious mental health conditions.

Clinical safeguards are failing to protect vulnerable people detained under this scheme. For example, we found that immigration removal centre staff identified five clients as being at risk of self-harm or suicide, but only one received the required Rule 35 (2) safeguarding report to alert the Home Office. Our research found high levels of suicidality among our clients, with one person attempting to take their own life and two self-harming in detention. Sadly, as reported by the Guardian, another person detained under the scheme attempted to end their life last month.

In shocking statistics published last month, Jesuit Refugee Service and Humans for Rights Network found that at least 141 age disputed young people have been detained under the scheme; at least 64 have subsequently either been found to be children by local authorities, or are in their care pending further inquiries; and 18 age disputed young people have been removed to France. Medical Justice had also previously flagged we had been receiving more referrals from age-disputed young people detained for forced removal to France than in any other cohort subject to immigration detention.

Importance of medical evidence

We have been told that in some cases our medical evidence was a significant factor in clients being dropped out of the UK-France scheme. Some clients dropped out have subsequently had their asylum claims considered in the UK and been granted refugee status. Medical Justice is also providing evidence for a potential legal challenge to particular aspects of the scheme.

Raising awareness and calling for scheme to be scrapped

Since the scheme’s inception, Medical Justice, alongside other charities, has consistently raised its concerns and called for the scheme to be scrapped. In September 2025, we joined the Immigration Law Practitioners Association (ILPA) and others in highlighting the lack of legal aid provision for those detained under scheme. We submitted evidence to the Home Affairs Committee in December 2025 We have also written to Home Office ministers with our findings. In February 2026, we teamed up with British and French NGOs in a joint statement on the harm caused by the scheme and witnessed by our organisations.

As secretariat of the APPG on Immigration Detention, we organised an expert briefing in November 2025 which was attended by MPs, peers and staff as well as clerks from the Home Affairs Committee, Joint Human Rights Committee and the Commons Library. Alongside speakers from Medical Justice, Gatwick Detainees Welfare Group and ILPA, we shared the testimony of a client who had been subjected to the use of force during an attempt to remove him to France, bringing the voices of those most affected by the scheme to parliament.

Widespread concern and independent scrutiny

Concerns about the harm caused by the scheme have been echoed widely beyond the charitable sector. In their annual report published yesterday, the Independent Monitoring Board reported that they were told the inclusion criteria for the scheme was “random by design” to undermine smuggling operations but that this resulted in leaving detained people highly confused. The IMB found systemic deficiencies in safeguarding mechanisms and was deeply concerned about their implications for people detained under the scheme whose vulnerabilities were “acute”.

In December 2025, nine UN experts led by the UN Special Rapporteur on the human rights of migrants wrote to the UK and French governments calling for the scheme to end. The UK government has yet to respond to their detailed concerns about potential human rights violations, including conditions of detention that may amount to breaches of Article 3 of the ECHR, failures to take measures to protect the right to life, and lack of protection for people in vulnerable situations (including victims of contemporary forms of slavery and trafficking in persons, unaccompanied children and survivors of torture).

HM Inspectorate of Prisons has published reports on two charter flights to France under the scheme, noting inadequate provision of interpretation – for example, the one in-person interpreter sent in November 2025 spoke languages understood by very few of the people being removed. This meant that many of those being removed could not ask questions or understand the process.

The Independent Chief Inspector of Borders and Immigration is carrying out an inspection of the implementation of the deal. Medical Justice submitted evidence and is awaiting the outcome of the review.

How you can take action

In light of serious human rights violations resulting from the scheme, Nadia Whittome MP has tabled an Early Day Motion urging the Government to end the pilot immediately and to work with international partners to establish safe, accessible and humane routes for people seeking protection.

Medical Justice is part of the campaign calling on MPs to sign the EDM. Please take a moment to email your MP and urge them to support the motion and end this cruel and inhumane policy. You can access a template email and take action on Care4Calais’s website here.

 

Medical Justice initiated a Judicial Review challenging the Home Office’s continuing failure to make provisions to enable people in immigration detention who lack mental capacity to participate in their immigration case or to challenge their detention or conditions of detention.

Though we were refused permission for the Judicial Review in September 2025, responding to our litigation the Home Office revealed a new policy which is likely to benefit detained people who lack mental capacity and be helpful to those supporting them.

The new policy provides that where there is medical evidence that a detained person lacks mental capacity (which Medical Justice might be able to provide) and they are not legally represented, the Home Office will not serve an immigration decision which carries a right of appeal or avenue to respond with submissions on them. This ends the situation whereby a detained person who lacks capacity does not understand or is unable to engage in an important and often negative decision against them – for example, the refusal of an asylum claim which, if unchallenged, could lead to deportation.

The Home Office also said it is “in the course of designing” a “new scheme” intended to provide meaningful assistance for detained people who lack mental capacity. Medical Justice will be following up to ensure this actually happens.

Background

In 2014 ‘VC’ was detained in an immigration removal centre (IRC). He had bipolar disorder and psychosis and had previously been admitted to psychiatric units multiple times. He remained in detention for close to 11 months during which time his mental health deteriorated. His healthcare records describe him as being confused, having delusions, persecutory thoughts, hypomania, elation, seeing visual hallucinations of angels, and presenting with ‘strange and challenging’  behaviour. He was described as having ‘lost contact with reality’ and not having insight into his illness. He was held in segregation in the IRC several times. Eventually he was sectioned and transferred to hospital.

VC was unable to arrange legal representation for himself and unable to challenge his own detention, the conditions in which he was held, or his repeated segregation. He was eventually encountered by an NGO that supports detained people who referred him to a solicitor. The Official Solicitor was appointed as ‘litigation friend’ because VC lacked capacity to represent himself.

In 2018 the Court of Appeal found that the Home Office’s failure to put in place assistance (such as independent advocacy) to enable VC to challenge his detention and conditions of detention was unlawful and discriminatory and a breach of the duty to make reasonable adjustments under the Equality Act 2010.

Seventeen months later, in July 2019, in the case of ASK and MDA the Court of Appeal made similar findings of discrimination in two further cases of mentally unwell detained men (ASK was another client of Medical Justice).

Following this a Detention Services Order (DSO) on ‘Mental Vulnerability’ has been developed, providing guidance to identify people who may lack mental capacity or who have a disability arising from their mental illness. The DSO instructs all staff to refer such concerns to healthcare and for the Home Office to be notified. Also, staff should assist individuals to understand information provided to them and legal documents served on them ‘through personal engagement’ and should signpost them to legal advice.

However, crucially, there is no provision for independent advocacy or some equivalent effective provision, as had been suggested in VC and ASK and MDA. If somebody is not able to understand or engage with a legal document served on them despite ‘personal engagement’ by an IRC  officer and is not able to attend a legal advice surgery and successfully secure legal representation, then they remain at high risk of remaining detained for long periods, despite the known deleterious effect of detention on mental health. They may not be able to pursue any potential asylum or human rights claims and could be removed from the UK without their circumstances being examined.

Home Office discloses policy following our litigation

Medical Justice applied for permission to challenge by way of Judicial Review the continuing failure by the Home Office to make provision for independent advocacy or other assistance for those in immigration detention who lack mental capacity. Although we were refused permission in September 2025 following an oral hearing (the judgment is here), in evidence in response to our litigation the Home Office stated that a “new scheme” is in “development and under active and ongoing consideration” and it is “considering the viability of a system of independent advocacy or equivalent arrangements”.

The Home Office also disclosed new ‘interim guidance‘ for its caseworkers which the Home Office stated was circulated to its teams in December 2024. The guidance states:

“Where the concern regarding mental capacity is considered well-founded and continues, but a decision is taken that detention is to be maintained, it is extremely important that the responsible case-working team can confirm that the person has legal representation. This will provide a legal avenue for immigration decisions to be appropriately challenged, notwithstanding the concerns that we may hold regarding the person’s mental capacity.

Where a person for whom we have a well-founded concern regarding mental capacity is not legally represented, and that concern is supported by medical evidence directly related to the capacity issue (HC MHT treatment etc), the service and enforcement of immigration decisions which carry a right of appeal or avenue to respond with submissions, should not normally be progressed, until legal representation is obtained. Whilst this general rule should normally be applied, each case must be considered according to its circumstances.” (emphasis added).

We have since seen instances where people who had strong indications that they lacked mental capacity to make decisions relating to their immigration case and were not able to challenge immigration decisions themselves, and who were not legally represented, were nevertheless served decisions, including refusals with a right of appeal and refusals that could have been responded to with submissions or challenged by judicial review. Some got close to being removed from the UK. Medical Justice is spreading the word about the “new interim guidance” to help ensure all detained people who lack mental capacity are protected in this situation.

This guidance may be an important tool to ensure deadlines are extended and people are not removed in the meantime.

Medical Justice is the only charity that sends independent clinicians into IRCs to document detained people’s mental and physical health, including mental capacity. Where appropriate, Medical Justice’s medico-legal assessments for detained people include assessments of their capacity to make decisions relating to their immigration cases or instruct legal representatives. If you have concerns about the capacity of a detained person, you can refer them to Medical Justice or contact our casework team to discuss.

The Home Office’s next steps

The judgment in the Medical Justice case records evidence provided by Frances Hardy, Deputy Director of Detention Services for the Home Office that:

“The Home Office is currently researching options to recruit ‘mental capacity officers’ from the current body of operational staff, who will receive specialised training, have oversight of cases of concern and the responsibility to liaise with the healthcare provider, making a referral for independent mental capacity advocates (IMCA) support where appropriate. This is the current intention of the Home Office, subject to the outcome of further policy development work in the coming months.”

It was further said that the viability of providing independent advocacy services was being considered.

So far no updated version of the Mental Vulnerability DSO has been published and there has been no further indication given to stakeholders (including Medical Justice) that the design of a system for the provision of appropriate support (including advocacy services) has progressed further or when such provision may start. Medical Justice is continuing our efforts to press the Home Office for this and highlight the ongoing need. In the meantime detention is being expanded.