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Annex A

The following provides a summary of the responses we received from forces to the eight questions we posed as part of this inspection.

1. In addition to any information you may have already supplied to the ACPOS health/medical services reference group relative to this area - has your force carried out any evaluations of the medical services provided to people in police custody? If so, what were the results of these evaluations?

1.a. About half of all police forces in Scotland had not carried out any formal evaluations of the medical services provided to people in police custody. Nevertheless a number had developed option appraisals for the future delivery of such services, mostly as a result of struggling to recruit and retain sufficient FMEs to provide coverage.

1.b. Grampian Police had conducted a review as part of its wider best value review of custody provision in May 2006.

1.c. Strathclyde Police had conducted a number of reviews into particular aspects of medical services, including both a best value review of police surgeon services in January 2002 and a thematic review of police casualty surgeons in August 2003.

1.d. Tayside Police had carried out a review of its provision of medical services by a private provider in February 2005. Northern Constabulary had completed a similar review with its private provider during 2006.

2. Did you seek independent advice when selecting partner agencies to work with the force in this area? Is there independent assessment of the services provided by partner organisations and the performance of the staff concerned?

2.a. Most forces managed their medical provision through the appointment of senior or principal FMEs who provided guidance and direction on clinical governance matters. Fife Constabulary was the only force to employ a full-time FME, attached to its Criminal Justice Department.

2.b. Though some benchmarking was evident in forces, few if any had used any external consultants to advise on service provision. This was seen as a result of the somewhat piecemeal way in which services had developed. The lack of a performance management regime in many forces is commented upon in the main report.

2.c. A number of forces had developed their provision through a competitive tendering process which had resulted in private companies operating in two forces (Northern Constabulary & Tayside Police) and the NHS operating under contract in another (Lothian & Borders Police).

2.d. Central Scotland Police was about to begin a multi-agency led review of its service provision. Some informal discussions, mainly with local health boards, were also evident in the responses.

3. What are your current processes for issuing prescribed medication to persons held in police custody?

3.a. All forces had processes and procedures in place for issuing and administering all medication to people held in custody. This was normally incorporated into forces' care and custody manuals or standard operating procedures. It came as no surprise to learn that FMEs played a central role in this process.

3.b. There was some divergence between and even within certain forces in the practice of issuing methadone. Medical advice appeared to vary in this respect, with clinical guidance and the length of time a person would remain in custody being the key factors in determining whether methadone was or was not issued. In view of the national prominence given to methadone and the high incidence of poly-drug use amongst many people in custody, we were somewhat surprised at the lack of consistent guidelines here.

4. Are any changes currently taking place in the infrastructure of your custody provision (building projects, centralisation of custody, etc.) or are any envisaged, which may have relevance to this thematic inspection?

4.a. Nearly all forces had or were planning to rationalise their custody facilities, the majority having no more than three main custody holding centres. This matter was explored in more depth in our recently published thematic inspection of custody facilities of March 2008.

4.b. The rationalisation of such facilities would undoubtedly make it easier to deliver medical services in a standardised fashion.

5. Are there any force processes, practices or procedures that you believe should be identified as good practice?

5.a. A number of areas of best practice were identified as a result of this review, and those that we felt would be most pertinent and have most impact on forces are contained within the main body of the report. These include:

• Drunk & Incapable Protocol (Fife Constabulary)
• Introduction of multi-disciplinary teams (Lothian and Borders Police)
• Mental Health Protocol (Tayside Police)

5.b. In addition, the following areas were highlighted by forces:

5.c. A number of forces also commented on the benefits of having a dedicated custody manager or non-clinical manager, responsible for all matters pertaining to custody including the provision of health care. This had generally led to improvements in efficiency, productivity and the achievement of best value through, for example, the innovative use of relief police custody support officers.

5.d. In addition, a number of forces hosted regular 'end user' and/or technical fora. Discussion and dissemination of learning points at these events ensured that best practice was promulgated throughout all force custody suites.

6. Does your force believe that the police service should still be responsible for the provision of this particular service or do you feel that efforts should be made to pass such responsibility on to the Health Service? Please supply additional comments, if possible.

6.a. Forces were unanimous in their desire to see the National Health Service assume ownership of this service, allowing partnerships to be created between the police, the National Health Service and other associated agencies.

6.b. Views and opinions expressed by individual forces have been incorporated into the arguments expounded within the main body of our report. These include difficulties in recruiting medical personnel, competing demands on such personnel, inefficient use of public resources, irregular geographical coverage, significant cost implications, and lack of consistency in service provision.

6.c. A resounding view expressed was that, whilst the police do make a positive contribution to the care and welfare of persons in custody, it must be recognised that the core business of custody suites is not to provide health care and that indeed health care is outwith the primary functions of the police service.

7. Do you have any other comments to offer which may be relevant to this particular thematic inspection?

7.a. All forces welcomed this thematic inspection, with a number expressing concern at the difficulty of securing adequate medical provision across their entire force area. Whilst the term 'crisis' was not used, it was clear that many were facing acute shortages in cover and all expressed fears for future provision.

7.b. This is a particular though not exclusive problem for rural areas within forces and, partly as a result of these difficulties, three Scottish forces had already entered into contracts with medical service providers. The difficulty of securing coverage was also the primary driver in at least two further forces which were actively discussing the possibility of achieving this through private providers. The pros and cons of such an approach are discussed in the main body of the report.

7.c. Ever rising costs was another issue, with around £8m to £9m being spent by all Scottish forces combined, annually. One force reported a 740% increase in costs over the last five years alone. Projected costs for all forces are expected to be even higher. To put this in some context, ACPOS reported that between 01 April 2007 and 31 March 2008 (the latest reporting period available), 215,711 individuals passed through police custody.

7.d. The important role of the ACPOS health/medical services reference group was also highlighted. Though we hope that this report will act as a platform for debate and reform, the role of the ACPOS group will be central in ensuring that any agenda for change is driven forward.

8. For EVERY individual who was taken into custody or detention (i.e. those who are under arrest or detained, or otherwise in custody, who are taken to a police station/office), during the month of February 2008, please could you provide the following information: (there followed a list of basic factual information requests such as reason for detention, age group, length of time in custody etc)

8.a. This question perhaps more than most highlighted the difficulties many forces have in accessing accurate management information in this area. With no national standardised performance management system in place as yet, many forces struggled to provide even a limited response. Systems in place at the time of our inspection offered only very limited search functionality and to provide comprehensive statistical analyses would have been very labour-intensive. Because of this, we asked forces to provide statistics only where this required reasonable effort on their part. This matter is explored further in the main report.

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