Provision of forensic medical services to police custody suites in England and Wales: Current practice

doi:10.1016/j.jflm.2008.09.002

Journal of Forensic and Legal Medicine

Volume 16, Issue 4, May 2009, Pages 189-195

https://doi.org/10.1016/j.jflm.2008.09.002 Get rights and content

Abstract

Introduction

Police services within England and Wales are required under the Police and Criminal Evidence Act 1984 to ensure appropriate healthcare to those detained in police custody (forensic medical services). Traditionally doctors have been used by police services to provide an appropriate level of care. Changes within the Act allowed other healthcare professionals (nurses and paramedics and emergency care practitioners) to be included in the provision of such services. The aim of this appears at least in part to have been to reduce the costs of providing such a service. In recent years police services within England and Wales have been outsourced to assorted commercial providers. There are now several different modes of delivery of forensic medical services, which are determined locally by separate police services.

Aims

This study aimed (a) to determine the different modes of delivery of forensic medical services in England and Wales; (b) to determine the healthcare workload caused by Police and Criminal Evidence Act 1984 Codes of Practice; (c) to determine the relative costs of different service models and (d) to determine availability of such information from the police services.

Methods

The study was undertaken in two parts – (a) a telephone survey of all police services, and (b) an application to each police service utilising the Freedom of Information Act 2000.

Results

All police services (n = 43) in England and Wales were contacted. Of the 41forces that furnished detailed information; 13/41 had a doctor only service; 20/41 had a doctor/nurse service; 6/41 had a doctor/nurse/paramedic service; 1/41 had a doctor/emergency care practitioner service (who may be nurses or paramedic); 1/41 had a doctor/paramedic service. 23/43 services were outsourced to private commercial providers. Mean cost per patient contact (in 17/43 services which supplied data) was GBP 97.25. The cheapest cost per patient contact was the Metropolitan Police Service – a doctor only service (GBP 56.4), the highest Lincolnshire – a doctor only service (GBP 151.1). Mean cost for a doctor only service was GBP 97.1; for a doctor/nurse service – GBP 91.56 and for a doctor/nurse/paramedic service – GBP 115.76. There was no significant difference in costs per patient contact between a doctor only versus mixed HCP delivery of service. Relative costs and 95% confidence intervals expressed as a percentage show that a doctor only model was on average 3.4% lower than a mixed HCP provision, and that a non-outsourced service was on average 9.9% less than an outsourced service. No outsourced service in this study uses a doctor only model.

Conclusions

The study shows that there was a complete lack of consistency in the recording and availability of information regarding forensic medical services for police services in England and Wales. The information that was obtained suggested that usage of such services varied greatly between police services and that costs of forensic medical services appear to be increased by the use of mixed healthcare professional service delivery and by using external commercial providers.

Section snippets

Background

In England and Wales, healthcare provision to detainees in police custody suites has traditionally been provided by forensic physicians (previously known as police surgeons) who would often be general practitioners (GPs – primary care physicians) in the community working in the custody setting on a part-time basis in addition to his or her GP work. In the last two decades, the terms forensic physician (FP) or forensic medical examiner (FME) have replaced the term police surgeon, in order to

Method

The study design was undertaken in two parts. Firstly, a structured email and telephone-based enquiry was undertaken of all police services in January 2008 and secondly a Freedom of Information (FOI) Inquiry under the Freedom of Information Act 2000 was made to all police services requesting detailed information concerning forensic medical services. The questions asked in the FOI Inquiry letter are shown in Fig. 1. Practising forensic physicians or police forensic services managers in each of

Results

Table 2a, Table 2b show the combined results within England and Wales. These show the responses to the questions posed in the letter asking for information under FOI. The most recent data are identified for years 2006 and 2007. Different police services have different annual reporting times (e.g. May–April, or January–December) and thus the responses from different services may reflect slightly different time periods. Data provided under the FOI application were variable between police

Discussion

The care of detainees in police custody is an important area of healthcare and police function. This is recognised in the publication Guidance on The Safer Detention and Handling of Persons in Police Custody.⁵ This document states ‘Many people who come into custody or police contact often do so with physical or mental vulnerabilities or both. There are often problems around alcohol or drug-related abuse or misuse. The Police Service often provides the gateway to healthcare services for those

Conflicts of interest statement

J.J.P.-J., W.A. and P.G. are all practising forensic physicians whose work may be affected by any changes in forensic medical services delivery.

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Original CommunicationProvision of forensic medical services to police custody suites in England and Wales: Current practice

Abstract

Introduction

Aims

Methods

Results

Conclusions

Section snippets

Background

Method

Results

Discussion

Conflicts of interest statement

J Clin Forensic Med.

J Clin Forensic Med

Healthcare issues of detainees in police custody in London, UK

J Forensic Legal Med

Original Communication
Provision of forensic medical services to police custody suites in England and Wales: Current practice