The National Audit Office has today published its report into the management arrangements of the new contracts between the Home Office and Serco and NHS England’s with G4S. The Home Office is responsible for all aspects of Yarl’s Wood except healthcare, which is now the responsibility of NHS England. Following the award of new contracts, Serco has run the residential services under contract to the Home Office since April 2015 and G4S has run the health services under contract to NHS England since September 2014.
Concerns about operations at Yarl’s Wood were first raised directly with the NAO in late 2014 to early 2015. HM Inspectorate of Prisons (HMIP) inspected the Centre in April 2015 and reported that detainees were generally positive about staff and a majority of detainees said that most staff treated them with respect. However, the reviews highlighted issues around the quality of the services and facilities provided and the extent to which residents’ needs are met. We waited until other independent reviews were completed to understand what caused the problems that had been identified. The NAO focused on the new contract management arrangements and how far the problems identified were caused by gaps in the new contracts between Home Office and Serco, and NHS England and G4S; or by contractors failing to fully implement the requirements of the contracts. We also examined what progress has been made since the reviews.
Today’s report found:
- There has been some significant progress since the independent reviews, although 35% of the recommendations from HMIP’s 2015 inspection have not yet been implemented. In particular, there have been improvements to healthcare facilities, the gender balance of operational staff, adult safeguarding and the residential regime. The CQC re-inspected healthcare at Yarl’s Wood in May 2016, and found that all the required improvements had been made, and there was only one area requiring further work.
- The Home Office did not reflect lessons from previous inspections when it agreed the service specification with Serco. Many of the concerns raised by HMIP in its 2015 inspection, for example, were raised in 2011 and 2013 prior to the new contracts. HMIP identified issues with the quality of Rule 35 reporting (the process for identifying vulnerable residents) and the role of male staff in searching female residents and their rooms.
- While the move to self-service in the residential services contract reduced demands on staff time, Serco’s reduction of staff meant there were insufficient operational and management staff. The contract envisaged freeing up staff time by moving to a ‘self-service’ model where, for example, residents send their own faxes and book their own visits.
- NHS England brought healthcare expertise but did not have a good understanding of the particular needs of residents when it designed the service specification. Although NHS England had over a year to prepare, the mental health service it initially commissioned did not meet the needs of the residents at Yarl’s Wood. In part, this was because it did not know enough about the health needs of people at the centre.
- Services at Yarl’s Wood did not fully meet the needs of users, in part because there was a lack of clarity about which contractor was responsible for what.
- The service specification takes some account of the diverse needs of residents but more can be done, particularly in the performance and financial regime. Indeed, there is an example where the performance model and other contract changes have indirectly led to worse treatment of residents. In the new contract the Home Office significantly increased the penalty for residents absconding, even though no resident had ever absconded, and now requires Serco to escort residents to out-of-area hospitals which are unfamiliar to staff and therefore carry higher risk. The Home Office has published guidelines on the use of restraints and handcuffs and a risk assessment must be performed before they are used. Partly as a result of these contractual changes, Serco adapted its risk assessment procedures for hospital visits in October 2015. Whereas three percent of women were handcuffed for hospital visits between October 2014 and April 2015 this figure rose to 11 percent for the same period the following year when the new approach was implemented.
- The contracts required that training should be provided but staff at the centre were not adequately trained to deal with the particular concerns, issues and vulnerabilities of those in immigration detention.
- G4S has been slow to meet its contractual obligations for training. It was required to provide training to all staff at Yarl’s Wood on mental health issues. Training was offered to Serco staff in April 2015, seven months after the start of the contract, but Serco were not able to take it up until October 2015. Although weaknesses in Rule 35 assessments were reported during the last three HMIP inspections, training to GPs was only provided by NHS England in July 2015, almost a year after the contract started.
- NHS England has limited powers to withhold payment if G4S does not deliver the service it is paying for, and has never withheld payment. NHS England did not withhold payments on the two occasions when it issued a ‘breach notice’ for G4S performance problems because it considered that they were quickly resolved. It has not set out how much it expects to recover in the event that G4S fail to deliver elements of the service it pays for.
- The Home Office contract is over-engineered and creates large theoretical financial credits for even trivial deviations from the contract. The Home Office is working on making it more streamlined. For example, if the Yarl’s Wood gym opens five minutes late then this could generate a service credit. If Serco keep the gym open for an extra five minutes at the end of the day, this would be acceptable mitigation and the service credit would not be imposed. The Home Office has imposed £56,000 of service credits out of a total of £585,600 credits generated, because it considered that there were mitigating circumstances for the vast majority of them. It is in the process of reducing the number of performance indicators from 120 to around 30, so that it can focus on any serious problems rather than requiring Serco to report every technical deviation from the contract and the mitigations it put in place.
- The Home Office and NHS England are content that the performance information they receive from their contractors is generally very accurate, although on a small number of occasions it has contained errors.