Following advice from public health England in relation to the emerging coronavirus situation we have made the decision to temporarily stop face to face medico-legal report assessments.
HBF is trying to adapt to the current situation where we are working remotely. As such we have produced some initial guidance we have produced for legal representatives and MLR writers:
A medico-legal report seeks to document the psychological and/or physical result of torture and other forms of ill-treatment to which an individual has been subjected. Medico-legal reports (MLRs) are written by appropriately qualified clinical experts and are commissioned by a legal representative who provides detailed instructions. MLRs are submitted to the Home Office or Tribunal in order to seek to corroborate a survivor’s testimony of ill-treatment as an aspect of their asylum, trafficking, and/or legal protection claim.
Each of our clinicians has been appropriately trained in the forensic documentation of the physical and/or psychological and emotional sequelae of torture, ill-treatment and other serious forms of physical, psychological, or sexual violence in accordance with the Istanbul Protocol.
Our clinicians expertise and appropriate experience in their field are recognised by the Home Office and the Tribunals. All of our clinicians receive ongoing training, mentoring and support with regard to the quality and integrity of our reports.
The Helen Bamber Foundation is officially recognised by the Home Office for its independence and expertise in identifying and treating victims of torture and other serious abuses (see API on Medico-Legal Reports).
Please see our referrals page for information on how to refer your client to us for a medico-legal report.
Once the case is accepted at our multi-disciplinary referrals meeting, we will email a Report Order Form (ROF) and Fee Quotation to the instructing party, together with a copy of our Terms and Conditions. Receipt of the signed Report Order Form constitutes the contract between the parties.
With the signed ROF (and not before), we ask for instructions by the legal representative, to direct the writer in their report. If you have not previously drafted a letter of instruction (LOI), please request a template LOI from our MLR Services Manager.
When instructing for a medico-legal report, we require a letter of instruction to be provided. Ordinarily we expect this to include the following:
- A list of documents provided;
- Details about the legal history of the case;
- Information about any issues regarding credibility or discrepancies;
- The background/history of trauma;
- An indication of the type of report required (and whether there are any understood to be no physical injuries; and
- Specific instructions you would like to be addressed by the clinician.
A medico-legal report from the Foundation will cover the following as standard:
1. Background & History of trauma
2. Physical injuries
3. Mental health
4. Clinical Plausibility
5. Treatment, recommendations, and prognosis
6. Fitness to give evidence
7. Fitness to be detained
8. Suicide risk (if relevant)
9. Risk & Vulnerability on return
Please include all legal documents and a complete set of medical records. Following receipt of instructions and full set of documents, we will make an appointment with the examining clinician.
Please see our Terms & Conditions for further information. Please refer to the section on Timescales below for further information on our turnaround time.*Important notice:
In sending documents to HBF to be considered as part of the MLR process, we request that large bundles of documents are separated into their component parts and sent as separate pdfs or a secure link to a cloud storage.
All documents should be named to indicate their contents. Indexed documents should be reflected in the instructions and/or HBF forms.
HBF does not have the capacity or means to separate out the contents of large bundles and we reserve the right to return such bundles unread with a request that they be appropriately separated and indexed. This may result in a delay in commencing the MLR process.
In order to continue to work in a GPDR compliant manner we request that large bundles are not sent to us by post and are instead scanned as set out above.
HBF strives to work in a ‘paperless environment.’ We therefore seek to avoid printing out papers sent to us.
As above, an appointment for an MLR assessment may only be made upon receipt of the required documentation. The instructing party is responsible for explaining to their client the purpose of the appointment to ensure they are aware of what this entails and why they are being assessed.
It is the instructing party’s responsibility to ensure that HBF is informed of their clients’ preferences in terms of both clinician and interpreter’s gender at the time of submission of the referral and specific instructions. It is essential that the instructing party consider any issue related to disclosure when doing so. Whenever possible it is HBF practice to allocate gender appropriate clinicians and interpreters. On occasion only a clinician and/or interpreter of a different gender may available within a reasonable timescale. To avoid delay, this arrangement will be offered. If this is inappropriate in the particular circumstances of the case, this must be made clear.
Upon prior request, a “chaperone” may be available to attend all or part of the examination. The instructing party has the responsibility to discuss this with the client in advance of any appointment, if advised to do so by the Foundation.
"A chaperone is an independent person, appropriately trained, whose role is to independently observe the examination/procedure undertaken by the doctor/health professional to assist the appropriate doctor-patient relationship."
A chaperone is present as a safeguard for all parties and is a witness to continuing consent.
The Foundation is not responsible for travel expenses incurred by clients during the preparation of Medico-Legal Reports. It is the instructing solicitors’ responsibility to assist clients in obtaining tickets for travel and any arising accommodation needs in advance of the assessment appointment(s). Where instructing solicitors have not arranged for their client travel and any arising accommodation needs, the Foundation will invoice the instructing solicitor for payments made by the Foundation to reimburse these costs to the client.
• Full Medico-legal Report (FULL MLR): physical assessment of scars/physical injuries and assessment of psychological/emotional sequelae attributed to ill-treatment – completed by a doctor (usually a GP)
• Psychiatric medico-legal report (Psych MLR): Psychiatric assessment –completed by a psychiatrist
• Psychological medico-legal report (Clin Psych MLR): Psychological assessment –completed by a clinical psychologist
• Addendum report (Add): Updated reports usually prepared by the original MLR writer
• Supplementary report: Additional report prepared by another specialist
• Response to refusal letter/rebuttal (R): (also headed Addendum report) a document we produce as a follow up to issuing an MLR, where there has been a decision which engages with or fails to engage appropriately with a previous MLR. This addendum report seeks to clarify issues raised in a decision by our clinical evidence. These are generally prepared by the original MLR writer closely supported by one of our legal officers
• Professional reports prepared by a treating HBF clinician. (Subject to capacity and only for clients who are receiving therapy at HBF)
Since February 2017, the Helen Bamber Foundation is required to charge an hourly rate for medico-legal reports or letters of clinical concern where the matter is funded by the Legal Aid Agency (LAA).
When a client is accepted for a medico-legal report, an estimated quote is sent, along with acceptance details. Estimated quote are usually calculated between 12 and 15 hours for the more straightforward cases (at the appropriate rate determined by the LAA from time to time) and are broken down as follows:
•Reading and other preparation:
Should we consider that extra funding is required, due to the complexity of the case, the number of documents to be read and considered, or following receipt of further instructions, the instructing party may be asked to seek additional funding from the LAA.
Delays in obtaining funding may result in corresponding delays in commencing or concluding an MLR as funding cannot be applied retrospectively and therefore work on a report cannot be carried out until HBF is notified that funding is in place.
When the report is finalised and delivered, the instructing party will only be invoiced for the actual hours spent by the clinician in the preparation of the report. The instructing party is required to pay within 30 days from the receipt of the medico-legal report.
Privately paying clients and reports undertaken pro bono
HBF may, in certain circumstances, agree to lower the quote where the client is not in receipt of legal aid. Please specify if the client is not legally aid when you submit the referral for a medico-legal report to HBF.
HBF’s capacity to produce pro bono reports is exceptionally limited. Please note that all requests for pro-bono reports have to be agreed at the time of the referral.
The Home Office Asylum Policy Instruction states the following on the estimated target date for completion of MLRs produced by HBF (Section 2.5 of the API):
“The Foundations aim to produce a full MLR within five months of the date that the legal representative or applicant has been notified in writing that the case has been placed on hold by the Home Office. However, flexibility is required when considering whether to delay cases beyond the five month target as there may be exceptional reasons for delay.”
HBF uses its best endeavours to comply with these target deadlines and, in many cases can produce reports within that timescale. Please note that the five month period starts from the date we receive the letter of instruction and the full set of documents.
Please advise of any upcoming deadlines or court hearing dates. Where possible, subject to HBF's capacity at any time, we will adjust the target date for completion of the report.
In circumstances where a hearing date has been set and our capacity does not permit us to produce a report in sufficient time, a letter may be requested explaining this. If requested prior to the examination, this letter will explain the anticipated target date for the preparation of the report. If requested post examination, the letter will describe those areas which it is anticipated will be covered by the report (to enable the instructing party to demonstrate the likely relevance of the report).
Pre-decision Legal Aid Agency concession
Please note that where a decision has yet to be made on an initial asylum claim, the LAA have agreed to the practice of granting funding pre-decision.
Please refer to paragraph 14.7 of the Escape Cases Electronic Handbook for Controlled Work (Last review date 21/04/17).
LAA Concession 2 - Alternative quotes
Where funding is sought for a report from Helen Bamber Foundation it is not necessary to obtain alternative quotations. The LAA CW3 checklist sets out that: “Where funding is sought for a report from either organisation it is not necessary to obtain alternative quotations. However, confirmation from the organisation that they have agreed to produce a report, the type of the report and the cost of the report must be provided.” (Point 15)
Please note that the Foundation does not disclose internal clinical records.
Should this be an issue please discuss this with the Head of Legal Protection and Co-Heads of Therapy.