Part E: Recommendations to prevent recurrence of mistreatment

67. Given the passage of time and contractual changes that have since occurred, I have considered carefully whether lessons have been learned and what action could be taken to prevent incidents like those shown in the Panorama programme from recurring.
68. There are a number of overarching themes that I have come across repeatedly. I have seen the damaging effect that indefinite detention has on detained people. People should not be detained indefinitely in a Category B specification environment for immigration purposes. In light of what I have found, I recommend that the Government introduce a time limit, whereby those detained at IRCs, including Brook House, should only be kept there for a maximum of 28 days.
69. The Home Office has ultimate safeguarding responsibility for the welfare of detained people. The process of subcontracting cannot remove that responsibility and it is unacceptable for the Home Office to attempt to delegate its fundamental role of caring for and protecting some of society’s most vulnerable people to its contractors. Similarly, it is inappropriate for the Home Office to rely on the monitoring of the IMB and/or HMIP as a substitute for conducting rigorous oversight of its own.
70. I have rejected the narrative portrayed by both the Home Office and G4S in their evidence, that events at Brook House were primarily the result of the behaviour of a small minority of staff. The evidence produced in the course of the Inquiry does not support this, and attempts to characterise the events in this way both minimise what occurred and seek to distance the Home Office and G4S from their responsibility for the prevailing culture. Many of the issues I have identified relate to a failure to follow the rules and safeguards that already exist in recognition of the risks associated with immigration detention. The troubling tendency to pay only superficial attention to the rules contributed to the toxic environment that existed at Brook House.
71. I have found that, too often, my findings closely mirror those from previous investigations and reviews into the treatment of detained people. Lessons must be learned, a culture of change must prevail and recommendations must be acted upon. The events that occurred at Brook House cannot be repeated.
72. A full list of my recommendations is contained in Part E in Volume II of the Report. I return to the former Home Secretary’s wish to learn lessons. On this occasion, lessons must be learned and more than mere lip service paid to my recommendations. The Home Office and others must publish details of the steps they will take in response to each recommendation, including the timetable involved, within six months of the publication of this Report.
73. Finally, the experiences of detained people lie at the heart of this Inquiry. No review of process or examination of policy should lose sight of the individual person who, whatever the reason for their detention, will inevitably find their life profoundly affected by the experience. It is for this reason that this Report begins with some of their accounts.