False economy on custody

More people will die in police custody and miscarriages of justice will become increasingly likely because of a U-turn by the home secretary, a leading forensic medical practitioner has told the Gazette.

Dr Jason Payne-James said that Theresa May had unexpectedly dropped longstanding plans to transfer to the NHS responsibility for the healthcare of people detained by the police. He said it was a ‘bizarre and perverse decision’ that she had failed to explain.

Though the decision was taken last year, NHS England appears not to have caught up with it. ‘At this time,’ its website said last week, ‘a change in legislation is still expected by April 2016 which will pass the legal responsibility for commissioning of custodial health services to NHS England.’

But May said four months ago that ‘a reallocation from the overall police settlement in respect of custody healthcare costs’ would not be ‘appropriate… at this time’. As one of her ministers told parliament in January, police and crime commissioners were informed in December that they would retain responsibility for these services. They would have ‘flexibility to prioritise resources towards police custody healthcare, based on local needs’.

But there is no suggestion that they will have any more money to spend. So the message to newly elected police commissioners is clear: find a company that will provide services on the cheap.

After a successful pilot in Dorset, work started as long ago as 2011 to prepare to ‘transfer the commissioning responsibility for all police custodial healthcare’ to NHS England, its website explains. The thinking is not difficult to understand. People needing medical care in police stations include some highly vulnerable patients – those under arrest or being questioned – as well as victims of crime and officers injured on duty.

Detainees are more likely than the population at large to be suffering from injuries, intoxication, withdrawal symptoms or mental health problems. Some have to be transferred by the police to places where they would rather not be – court, prison, immigration centres or mental health units. Many are young and an increasing number are old.

Clearly, the police need access to a range of healthcare professionals with the skills to assess and manage prisoners. These doctors, nurses and paramedics may also be needed to take forensic samples from suspects and give evidence in court. But the budgets from which police forces are meant to fund those services are unrealistic, according to Payne-James, a consultant forensic physician. As president of the Faculty of Forensic & Legal Medicine at the Royal College of Physicians, he reports that many forces are using staff with no more than a few days’ training to treat and manage some of the most high-risk and vulnerable patients in society.

‘Some private commercial providers have placed advertisements for healthcare staff that require little or no previous experience in this setting,’ he said. ‘These offer a three-day training period before the professional starts work, unsupervised, in a complex, unfamiliar environment, with little or no mentoring or advice immediately available. There are already signs that NHS sexual assault services are not meeting agreed standards.’

Payne-James recalled the case of a doctor who was tried for gross negligence manslaughter after a man he had been called to examine died at a London police station in 2009. He was found to have been negligent, though not guilty of a criminal offence. Payne-James said the doctor had never been trained in the field of police custodial medicine.

Last November, Payne-James tried to persuade ministers that the transfer to NHS England should be delayed until minimum standards and funding had been agreed. At a meeting later that month, the government insisted that the change would go ahead in April 2016, regardless of the concerns expressed by doctors, nurses and paramedics working in police custody suites. Within three weeks, the policy had been cancelled.

Ben Gummer, a minister at the Department of Health, distanced his department from the change of plan. In a letter to Payne-James, he said pointedly that the decision had been taken by the home secretary. Gummer recognised that the faculty had been ‘working hard to pave the way for successful transition’ and hoped that cooperation would lead to improved clinical standards.

But he offered no advice on how this might be achieved. Payne-James said the faculty would be contacting the police and crime commissioners elected this month to ensure they understood the implications of May’s decision. ‘Unless the police insist on minimum standards of  training, skills and qualifications,’ he said, ‘healthcare in custody will be further degraded. This will increase the risk of death or serious incidents in custody and make miscarriages of justice more likely.’

And, inevitably, it is bound to be be a false economy: prevention is always cheaper than cure.