Healthcare safeguarding reports: Rule 35 and Rule 32
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Any clinician assessing a detained person has a duty under either Rule 35 DCR 2001 or Rule 32 of the STHF Rules 2018 to complete a report if any of the following apply:
(1) The detained person’s “health is likely to be injuriously affected by continued detention or any conditions of detention”
(2) The clinician “suspects [the detained person] of having suicidal intentions”
(3) The clinician is “… is concerned [the detained person] may have been the victim of torture”
There is a distinction as the DCR 2001 which apply in IRCs require that these safeguarding reports can only be completed by a GP. In STHF, the 2018 Rules that apply there, allow both nurses and GPs to complete them.
The safeguarding reports are commonly referred to by the number of the Rule (i.e. Rule 35) and the corresponding number of the individual circumstances (i.e. 1, 2 or 3 of the sub-headings above). For example, a ‘Rule 35(1) report’ is one completed by a GP at an IRC who considers that their patient’s health will be adversely affected by detention. Or a ‘Rule 32(3) report’ which would be completed by a nurse at a STHF concerned that their patient had disclosed a history of torture.
The guidance states that where a detained person falls within more than one category, the clinician must complete a separate report for each element of R35/32. Each time a report is completed a copy must be given to the detained person.
A key aspect to understand about the healthcare safeguarding reporting process is that the only standard time that a detained person will be considered for a Rule 35 or Rule 32 assessment is following their arrival in a place of detention, i.e. when they are offered screening when they are taken into detention or if they are transferred within the detention estate.
However, it is possible for the detained person to request a Rule 35/32 assessment at a later stage in their detention, although there is no time limit for any such appointment to be arranged. It is also possible for clinicians in STHF or IRCs to complete an assessment and safeguarding report of their own volition, but this is dependent on training for clinicians to recognise the need for this, rather than policy itself that timetables such an assessment.
R35/32(1) report: a person’s health is likely to be injuriously affected by continued detention or the conditions of detention
Where a clinician considers that the person’s health is likely to be worsened by detention then they need to complete set out in the guidance. This requires an explanation of the following issues:
“Why is the detainee’s physical and/or mental health likely to be injuriously affected by continued detention or the conditions of detention?”
What treatment is the detainee receiving? Is specialist input being provided, either within the IRC/STHF or as a hospital outpatient or inpatient?
In the case of mental health problems, has there been a detailed mental health assessment and, if so, carried out by whom and with what result/recommendation? If not, is an assessment scheduled to take place and, if so, when?
What impact is detention or the conditions of detention having (or likely to have) on the detainee’s health and why?
Can remedial action be taken to minimise the risks to the detainee’s health whilst in detention? If so, what action and in what timeframe?
If the risks to the detainee’s health are not yet serious, are they assessed as likely to become so in a particular timeframe (ie in a matter of days or weeks, or only if detention continued for an appreciably longer period)?
How would release from detention affect the detainee’s health? What alternative care and/or treatment might be available in the community that is not available in detention?
Are there any special considerations that need to be taken into account if the detainee were to be released? Can the detainee travel independently to a release address?”
R35/32 (2) report: the clinician suspects the detained person of having suicidal intentions
Please state the reasons for suspecting that the detainee has suicidal intentions?
Is the person detained being managed under Assessment Care in Detention Teamwork (ACDT) arrangements? If not, why not?
Can the suicide risk be managed/reduced satisfactorily through ACDT, medication and/or appropriate interventions such as talking therapies?
What arrangements might be needed to manage the detainee’s suicide risk in a non-detained setting?
Has there been a mental health assessment? If so, what was its result/recommendation? If not, is an assessment scheduled to take place and, if so, when?
R35/32 (3) report: the clinician is concerned the detained person may have been the victim of torture
The definition of torture included in the guidance is ““Any act by which a perpetrator intentionally inflicts severe pain or suffering on a victim in a situation in which
(a) the perpetrator has control (whether mental or physical) over the victim, and
(b) as a result of that control, the victim is powerless to resist.”
The template report requires the clinician to explain the detained person’s account of their torture including, if possible “when, where, how, over what timeframe and why the torture is said to have happened.” The form seeks to gather both the detained person’s account of their experience (as well as their explanation of any injuries, scarring or physical or psychological symptoms caused by this) and also a brief medical assessment. The report requires the clinician to provide details of their own observations and findings concerning their patient including:
“details of all scarring or other physical marks, psychological symptoms, physical disability or impairment.
details of any medical or professional treatment or support that the detainee has received (including outside the UK) or is receiving and from whom.
any information in respect of previous or current physical or mental health problems which may be a result of having been tortured.”
The complexity of this assessment is underlined by the guidance that accompanies Rule 32(3) / Rule 35(3) reports which also requires the clinician to include an explanation of whether the “torture allegation” derives from “low or limited evidence” in support of the person’s account. The Adults at Risk Guidance (January 2025) gives more detail about how a clinician should approach assessing whether a person is a victim of torture.
Any time a Rule 35/32 report is made the detained person must give consent to share this information with the Home Office.[1] If consent is not given then the report goes no further and there is no review of detention. A detained person must also be given a copy of the report.
If consent to share the report is given, it is sent by healthcare to the Home Office. The guidance sets out in some detail the internal process within the Home Office for circulating this information, documenting that this has happened and assessing whether the relevant information is contained in the report. The Home Office must review the person’s detention (by applying the AAR policy) by the end of the second working day after receipt of the report. This triggers a decision to either maintain detention or release the individual, with an accompanying obligation to provide a written response to the detained person, their legal representative (if they have one) and to the detention site’s healthcare. Further, under the guidance, clinicians have a responsibility to escalate their safeguarding concerns if they do not think their concerns have been properly addressed by the Home Office.
Detained people are entitled to be seen by their own doctor under Rule 33 (7) DCR 2001 or Rule 31(7) STHF 2018 subject to the discretion of the detention site’s manager. This means in practice that an independent clinician (usually organised by an NGO or a legal representative) should have access to see a detained person in order to complete a medical assessment and report. This is a core aspect of the work undertaken by Medical Justice who can organise of an independent medical assessment for people in detention. These medical assessments when written up are often known as medico-legal reports as they are drafted by the clinician to explain their findings with input from people with legal training.
The guidance states that where reports from “third parties about a detainee’s health or allegations that they are the victim of torture” are received, as a matter of best practice these documents should be sent to the detention site’s healthcare practitioner who should review whether or not to make a Rule 32 or 35 report. Independent medical reports should also be sent to the Home Office decision-maker who will review this evidence in light of AAR and so decide whether the person should be released, but the guidance is silent on the timeframe for this decision except to say they are not subject to the same strict timetable as when a Rule 32/35 report is provided.
Where an independent report states a detained person is feeling suicidal then this needs to be brought to the immediate attention of IRC/STHF healthcare and the Home Office.
Caselaw has established the importance of Rule 34 and Rule 35 in ensuring that detention is lawful in individual circumstances. The Courts have been clear that there is an obligation on detaining authorities to provide a mechanism to ensuring safeguarding happens.[2] This includes medical assessments which identify people who fall within the terms of Rule 35/32 and so trigger a review of detention. Where no such assessment was offered, or the Home Office decision-makers did not properly consider a medical report in accordance with policy, then the person may be unlawfully detained. If the person remains in detention at the time of the court’s decision, then the judge can order the release of the individual. People who have been unlawfully detained are also likely to be entitled to financial compensation.
[2] R (on the application of D and K) v. Secretary of State for the Home Department [2006] EWHC 980 (Admin)
Again, there is that clinicians are required to complete. This addresses the following issues:
The explanation of the concept of torture has been the subject of litigation, but the requires the clinician to focus on whether the person was in a situation of powerlessness.
[1] There is (May 2016) on sharing of information in these circumstances
The process of healthcare’s involvement in identifying people who are particularly at risk of harm by detention and reporting such information to the Home Office is presently the subject of a consultation by the Home Office commenced in March 2025.
Look out for the end of the Home Office consultation process and for any changes to healthcare’s role in screening and reporting on vulnerability.