The Faculty of Forensic & Legal Medicine (FFLM) welcomes the Equality and Human Rights Commission’s (EHRC) report ‘Non-natural Deaths Following Prison & Police Custody’ which spotlights concerns about post-release deaths from both police and prison custody. Unfortunately it follows several other reports from various bodies noting similar concerns, which to date seem to have been ignored.
The FFLM has a specific interest in police custodial healthcare and has long been critical of the previous Home Secretary’s abrupt decision to cancel the process of transfer of police custodial healthcare services to the NHS in England & Wales exactly a year ago. This was in planning for four years and was to be implemented in April 2016. The cancellation has maintained continued fragmentation of a healthcare service in which there is a distinct lack of consistent approach across the police services in England & Wales, with no minimum standards of skills, training or qualifications for those doctors, nurses and paramedics who provide such services. In Scotland, such a transfer has been implemented with success. The FFLM and our clinical partners, the United Kingdom Association of Forensic Nurses and Paramedics (UKAFN) and the College of Paramedics (CoP) believe strongly that the cancellation of the NHS transfer substantially reduces patients’ safety. We have recommended minimum standards for healthcare professionals working in police custody but we are aware of many situations where such standards are far from being implemented, giving rise to the concerns raised in the EHRC report.
The previous Home Secretary commissioned an Independent Review into Deaths and Serious Incidents in Police Custody and it appears to have been a bizarre and perverse decision to cancel the single process that could have resulted in raised standards and a consistency of approach before that review was completed.
The over-representation of drug and alcohol dependence and mental health issues in our patient population is well-recognised in prison and police custody. The physical health issues, and the vulnerability conferred (even on those in good physical and mental health) by arrest is less well-recognised, and the EHRC does a service by highlighting this issue. Whether action is taken to address these and other EHRC concerns is entirely in the hands of politicians.
The FFLM recommends in the interests of patient safety that the previously planned NHS transfer is immediately restarted and calls upon the Home Secretary and Government to implement this.
NOTE TO EDITORS:
The issues described in the EHRC report (see here) and their solutions are already well-known. The problems are mainly caused by inadequate resources (financial and personnel) and inconsistent quality of care and delivery across police services, mental health services, drug and alcohol teams, social care and healthcare professionals. Many of the problems are caused by absent, inadequate or ineffective training. Many custody suites, despite the Mental Health Crisis Care Concordat, across England & Wales do not have ready access to Mental Health Liaison and Diversion teams. Many custody suites have no access to Summary Care Records for detainees, which would be accessible under NHS provision. Where Summary Care Records are accessible, many detainees will not be registered with a general practitioner and thus will not have a Summary Care Record. If a healthcare professional makes a recommendation or referral to services (e.g. mental health team, homeless teams), the ‘referral’ may consist of providing someone with a telephone number. Many police officers are not aware of the College of Policing’s excellent Authorised Professional Practice. Many of those responsible for the care of detainees (custody officers, detention officers, gaolers, doctors, nurses and paramedics) will not be aware of the Independent Police Complaints Commission’s ‘Learning the Lessons’ bulletins. There are many other examples of inadequacy or failure of training or service provision. There may be inconsistencies between IPCC findings and subsequent inquest conclusion. This latter aspect is currently the subject of research.
In addition to these examples of aspiration/reality gap is the belief that the risk that someone may commit suicide after release from custody can be accurately and reliably predicted. It cannot. Some deaths will always be unpredictable and not preventable. However if the strategies and systems described above were adequately funded and staffed, if the transfer of police custodial healthcare services in England & Wales to the NHS were to go ahead, if the minimum standards of healthcare professionals advised by the FFLLM, UKAFN and CoP were implemented, if all police personnel were aware of and followed APP, if Learning the Lessons Bulletins were appropriately disseminated, then the tragedies of preventable deaths and serious incidents in police custody and deaths after release from police custody might be minimised.
About the FFLM
The Faculty of Forensic & Legal Medicine (FFLM) of the Royal College of Physicians has the twin aims of developing and maintaining the highest possible standards of competence and professional integrity in forensic and legal medicine. The specialty covers professionals working in three related disciplines: forensic medical practitioners (forensic physicians, forensic pathologists, sexual assault examiners, and child physical and sexual assault examiners); medico-legal advisers; and medically-qualified coroners.