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SUMMARY OF RECOMMENDATIONS
The provision of medical services to people in police custody is coming under increased scrutiny by the police service in Scotland and beyond. Such services - whether for treatment, assessing fitness for interview or appearance in court, or a range of other associated purposes - are delivered in a number of different ways across Scotland and are often closely associated or completely integrated with forensic medical services.
The development of forensic medical services has itself evolved in piecemeal fashion over many years. Doctors providing forensic and other medical services to police forces used to be known as police surgeons. This is still the case in some places, although the more frequently used terms today are forensic medical examiner ( FME), or forensic physician, even when the service being provided is not just forensic. In fact, forces reported an approximate 85-15% split between the welfare (therapeutic) and forensic examinations respectively that they carry out. The majority of FMEs are also general practitioners who combine police work with their own patient lists.
More recently, changes to contracts, the introduction of modern working medical practices and further legislative requirements have made it increasingly difficult for forces to fulfil their statutory and other obligations to people in custody, and have had a significant knock-on effect on the workings of the criminal justice system. The constant struggle to recruit and retain sufficient doctors, difficulties in securing prompt and/or continuous medical attendance in terms of 24-hour coverage and geographical spread, and general variability in the subsequent quality of service are commonly cited problems.
Following an inspection of current arrangements in this area, HM Inspectorate of Constabulary for Scotland ( HMICS) makes the following recommendations:
Recommendation 1: We find merit in the projects currently taking place in Fife involving the Scottish Ambulance Service ( SAS), National Health Service ( NHS) Fife and Fife Constabulary. Individual police forces are therefore encouraged to work in partnership with local authorities, health and other agencies to establish best practice in dealing with drunk and incapable people, within the context of locally available services and resources.
Recommendation 2: That the police service in Scotland actively participates in proposed research on identifying appropriate means of supporting and dealing with drunk and incapable people including the use of designated places of safety.
Recommendation 3: That, whilst the long-term approach could be to transfer responsibility for medical services to the NHS, forces in the meantime collaborate with the NHS to introduce multi-disciplinary clinical personnel into their custody facilities.
Recommendation 4: That the Tayside Psychiatric Assessment Protocol be viewed as good practice, and that other police forces in Scotland pursue a similar approach.
Recommendation 5: That the Association of Chief Police Officers in Scotland ( ACPOS), via its National Custody Forum, create and incorporate common performance management information within the developing national custody system. This would give forces, police authorities/boards, and the health service a shared understanding of what should be expected and delivered across Scotland.
Forces may wish to work together to discharge the recommendations relating to the police service under the co-ordination of the ACPOS health/medical services reference group. In accordance with our statutory remit, however, we will continue to review the arrangements of individual forces.
HMICS is independent of police forces, police authorities and the Scottish Government, and exists to monitor and improve the quality and standards of service provided by the police service in Scotland, and to ensure that the public get the best value possible. In seeking to achieve this HMICS focuses on particular themes across all the police organisations in order to identify, contribute to, and communicate good practice, and to highlight areas of performance that need to be addressed. Often such reviews will, through necessity, cross service boundaries and involve other organisations. This review is no different in that. Whilst a number of our recommendations are aimed at individual police forces, there are also several areas highlighted in the report which would benefit greatly from the commitment and influence of other partners, particularly the Scottish Government and the NHS.
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