Medical evidence may be submitted but the initiative for obtaining a report comes from the applicant or their lawyer. There is no legal provision which requires the provision of a report for the purposes of the asylum claim.
Asylum Policy Guidance on medical evidence provides for the possibility of delaying an asylum decision pending receipt of a medical report from the NGOs Helen Bamber Foundation (HBF) or Freedom from Torture (FTT) or other reputable provider using rigorous methodology in preparation of its reports. FFT and the Helen Bamber Foundation are the most established organisations which prepare medico-legal reports, and their work is widely respected. Referral to obtain an appointment for a Medico-Legal report from specialist providers can normally only be made by a lawyer, and referrals may be accepted if the providers consider that a medico-legal report has the potential to make a material difference to the outcome of the claim. If a report is received after a refusal of asylum the case must be reviewed.
Home Office caseworkers make this decision and should act reasonably. They are required to take into account whether the applicant declared a medical condition at the screening interview, whether there is written evidence of an appointment with a medical professional, and the length of time the applicant has been in the country and so had the opportunity to consult a medical practitioner. The guidance advises on timescales for delaying interviews and/or decisions following consideration of the relevance of a report e.g. decision makers are not required to delay if the person is to be granted protection anyway, or the medical evidence is not considered material to the claim. All such decisions must be discussed with another decision maker (second pair of eyes process).
Where a solicitor is funded by legal aid they can request authority from the Legal Aid Agency for payment for medical reports, and this may be granted depending on the relevance and importance of the report to the claim. The solicitor has authority to spend £400 (approx. €460) on an expert report without involving the Legal Aid Agency, but this is often not adequate to fund a full expert report.
The Detention Centre rules require that a medical examination should be conducted within 24 hours of arrival in a detention centre, but this must not be used in determining the asylum claim; its purpose is to ascertain fitness for detention.
Medical reports may be prepared based on the Istanbul Protocol, and this is regarded as best practice and is standard for experienced practitioners. The NGO Freedom From Torture has addressed the issue of decision making for torture survivors in several reports; a specific one that focused on decision making involving Medico Legal Reports, an issue also raised in a critique of the standard of proof applied in asylum decisions, and an analysis of the way torture is dealt with in asylum interviews.
The long running case of KV (Sri Lanka) progressed to the Supreme Court and judgment was handed down in March 2019. The case concerned the question of the extent to which a medical expert could comment on the likelihood of torture being self-inflicted by proxy, that is, by another person at his invitation. Whilst the Supreme Court remits the case to the Upper Tribunal to reconsider, it invites the Upper Tribunal to note that very considerable weight should be given to the fact that injuries which are self-inflicted by proxy are likely to be extremely rare.
 Rule 34 Detention Centre Rules.
 Office of the United Nations High Commissioner for Human Rights, Manual on the effective investigation and documentation of torture and other cruel, inhuman or degrading treatment or punishment, ‘Istanbul Protocol’, 2004, available at: http://bit.ly/1DVAApu.