Handing NHS data to the Home OfficeBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j911 (Published 22 February 2017) Cite this as: BMJ 2017;356:j911
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Anne Gulland reports that the data to be handed to the Home Office by NHS Digital is not expected to include clinical information1.This may not apply for those held in immigration detention.
The details are in a Detention Services Order (DSO) re-released in May 20162. The specimen consent form says: “I hereby give my informed consent for a copy of my healthcare/medical information to be released to the Home Office. I confirm that I have had explained to me and fully understand that this (ie the purpose for this information sharing) is in conjunction with my immigration matters and may be shared with other agencies (from the list below) as deemed necessary by the Home Office after I sign this form. I understand that the information I have allowed to be released to the Home Office will be treated in confidence but may be disclosed to other government departments, agencies, foreign governments and other bodies for immigration purposes.”
This is being expected to be signed by a person held in administrative detention, often in a language foreign to them, without legal advice or other advocacy support for the many with mental illness or who lack mental capacity3. It has been described as ‘non-consent obtained under duress’4. It is unclear what medical advice is available to the Home Office to interpret these routine clinical records. Such information may be used to rebut asylum claims relating to sexuality or torture or mental illness, say on the basis of the lack of a relevant record in the induction medicals done on arrival into detention. The DSO reasons that clinical information can be released even without consent, in the context of determining fitness to fly, quoting the need to support the ‘exercise of any functions of a government body’. This appears to anticipate Clause 30 of the Digital Economy Bill 20175.
The NHS now runs health services within detention centres but the Home Office expects compliance with their requests. Hopefully clinicians within immigration detention centres will remember and follow their standard professional guidelines. If a clinical report is needed to support an asylum claim, there is a system for specifically tailored reports, made with the patient’s consent. This rule 35 system has been much criticised, however, not least for the frequency with which the Home Office fails to heed such advice.
Were healthcare staff in detention centres to comply with such Home Office requests, this may be inconsistent with professional guidelines and could well lead to other NHS colleagues becoming reluctant to provide information on the patients they share. It could add yet further to the reluctance of irregular migrants to seek the healthcare they need.
1. Anne Gulland. Handing NHS data to the Home Office. BMJ 2017;356:j911
2. Detention Services order 01/2016 The Protection, Use and Sharing of Medical Information Relating to People detained Under Immigration Powers on www.gov.uk/government/uploads/system/uploads/attachment_data/file/524505...
3. Grant-Peterkin H, Pickles H and Katona C. Mental capacity of those in immigration detention in the UK Medicine, Science and the Law 2016; 56:285-292
4. John Chisholm (BMA) quoted in the APPG Inquiry into the Use of Immigration Detention in the United Kingdom 2015
5. Delegated Powers and Regulatory Reform Committee. Thirteenth report. Digital Economy Bill: Parts 5-7 on publications.parliament.uk (accessed 25 Feb 2017)
Competing interests: No competing interests