Project Herald - changes to MPS forensic medical provision

Report: 8
Date: 07 February 2008
By: Assistant Commissioner Territorial Policing on behalf of the Commissioner

Summary

Project Herald proposes to introduce a new custody-staffing model, which aims to deliver a more efficient, safer custody environment. This report focuses on arrangements for forensic medical provision within police custody suites.

A. Recommendations

That:

members support the proposed new arrangements for the forensic medical provision within custody suites and agree the proposed financial arrangements.

B. Supporting information

1. In May 2004, the Service Improvement Review into Custody Capacity (SIRCC) formally acknowledged and highlighted the increasing difficulties being encountered within the MPS through a lack of cell availability and delays occurring within the current custody process. These inefficiencies have a contributory affect on throughput times for detainees and therefore a potential negative impact on safety. Project Herald aims to address some of these issues through three strands: one. Multi-disciplinary clinical team, led by a Forensic Medical Examiners (FME) and incorporating nurses as healthcare professionals within custody suites, 2. The extension of the current Designated Detention Officers’ duties to include an inputting role, and 3. The introduction of 24 hour Forensic Practitioners advice.

2. This report deals solely with the proposal for a multi-disciplinary clinical team of FMEs and incorporating nurses as healthcare professionals within custody. This new approach will provide 24/7 medical practitioner availability in custody suites, providing improved care for all detainees.

3. The drivers for change in relation to custody forensic medical provision are threefold.

4. First, the current situation relies upon a custody sergeant – untrained medically in the main – making an assessment of a detainee to determine whether an FME examination is required. Custody officers generally do a very good job, but there are examples where potential signs that a medical emergency is looming have been missed (Death of Enzo Stompanato, inquest in 2006, for example).

5. Second, many custody processes rely on an assessment of a detainee’s fitness to be dealt with in the first instance. This is usually a judgement by the custody officer but often-crucial medical evidence for disclosure to the defence team and for use in interviews is also required. Where it is deemed necessary for such forensic medical interventions, the current system requires a FME to be called. All subsequent processes (e.g. solicitors attendance; investigating officers assessment of evidence and interview planning) are delayed pending the arrival of the FME unless he or she happens to already be at the relevant custody office. Data analysis has demonstrated that, in 38% of cases, delays awaiting the arrival of the FME are between 1 and 1.5 hours. A permanent team of healthcare professionals will significantly decrease this delay and will be potentially far safer. A FME will still be available for referrals by the healthcare professional and, with the proposed new arrangements in place, the FME will be easily obtainable, operating in a more mobile role overseeing a number of custody suites.

6. Third, the current system of payment for FMEs is based on a fee-per-case. The MPS has little control over the budget for forensic medical services, as it is entirely demand driven. The current system allows for multiple detainee examinations during a single visit to attract significant fees during a relatively short attendance in the custody office. Conversely, FMEs may see far fewer detainees over a significantly longer period and generate only modest fees. This raises issues regarding the appropriateness of the current system, hence the proposed move to sessional fees. Additionally, MPS/MPA control of budget for planning and demonstration of fiscal prudence is vital.

7. The herald model has been derived from an extensive MPS review and a custody medical needs workshop, encompassing external as well as internal stakeholders and subject matter experts. Additionally, a review by current FMEs on ways in which the service may be improved was conducted and an options paper produced. Commonality exists in that both suggest a 24/7 forensic medical practitioner’s presence in custody would provide improvements in the areas highlighted. Both also agree that a sessional fee for FMEs would be both a more controllable and a fairer way of dealing with the financial arrangements.

Improved medical provision in custody

8. It is acknowledged that the proposal outlined in this paper represents substantial change and significant impact, specifically for FMEs. Working practices for all involved in the provision of MPS custody services are set to change considerably. To manage these changes, the Herald Project Board will play a pivotal role in ensuring that relevant areas of change have appropriate levels of consultation completed, communication of change is managed and options are properly considered before decisions are made. The involvement of the Commissioners Advisory Panel (CAP) on forensic medical matters will also provide appropriate advice on medical and professional issues. A comprehensive project delivery plan, benefits plan and risk register have been compiled and will form the basis of the consultation/communication plans involving the wider audience, which commences with open meetings with FMEs on 31 January and 2 February.

9. The benefits and risks/challenges of the new approach are set out below:

Benefits

• Speedier medical assessment and forensic medical recovery#
• Providing improved care for all detainees
• Reduction in overtime costs / detention times due to delays in waiting for FMEs to attend custody
• Improved processing times
• Improving services to victims and witnesses
• Improving supervision of the Criminal Justice process at the early stages
• Meeting strategic objectives and demonstrating best value by making better use of resources
• Reducing the risk to the investigation / organisation due to delays in processing
• Increasing cell availability due to timely processing of detainees

In addition to the above benefits, positive feedback regarding Project Herald proposals have already been received from the Independent Custody Visitors (ICVs), Independent Police Complaints Commission (IPCC) and the Home Office.

Risks and challenges

• Recruitment of sufficient, appropriately skilled staff to fulfil the functions of the Custody Nurse role
• Sufficient training availability
• Contingency plans to cover periods of long term absence, as custody nurses are difficult to replace or cover
• Custody nurses will not be available to perform their primary role if attending court so alternative options will need to be considered i.e.: serving of statements
• Guaranteed funding required to sustain the three-year roll out
• Additional equipment required, the costs of which will need to be met from within the overall budget or by TP

The risks and challenges shown above will be managed by TP Emerald through the project implementation process in order to minimise the impact.

Conclusion

10. Project Herald supports the Met Modernisation Programme, Custody and Workforce Modernisation strands by creating a more streamlined approach to the staffing of custody suites, and is totally committed in its focus on improving safety, making efficiency gains and enhancing the quality of service through more appropriate use of resources.

11. Through the development of the Custody Nurse and the enhancement to the existing MPS roles, the standard of custody services within the MPS will be significantly improved.

C. Race and equality impact

The project is likely to introduce greater female representation within healthcare provision for detainees because a greater proportion of nurses tend to be female whilst the majority of current FMEs are male. Further information in the form of an Equality Impact Assessment is attached at Appendix 1.

D. Financial implications

1. There are no capital costs associated with the implementation of this initiative. Any capital costs relating to the transfer of function to the new BBCCs has been to date, and will be in the future, covered in the business cases prepared for the delivery of each BBCC.

2. The table below shows the current and estimated costs of providing nurses in custody suites, together with the savings identified to offset the increased staffing costs. It is based on a phased rollout, recognising the need to stage recruitment over a number of years, and assumes the employment of 50 nurses in 2008/09, 75 nurses in 2009/10 and 75 nurses in 2010/11.

Table 1: Herald - estimated costs of deployment of nurses in custody suites

3. Training and recruitment costs, together with one-off accommodation costs (such as lockers) have been included in the table as costs to be covered from within TP budgets.

4. Investment Board has agreed £6.35 million from the MMP budget for transitional funding through the implementation of the full Herald staffing model. It will be necessary to utilise £1.1 million of this fund in 2008/9 to cover the transitional costs of introducing the nurses before savings can be achieved from 09/10 and beyond.

5. The savings in years 2009/10 and 2010/11 will contribute to the start-up costs of the implementation of the full Herald model, which has yet to be presented to the MPA. It is suggested therefore that the savings are not available to off-set any other shortfalls in TP or MPS budgets for future years.

E. Background papers

• August 2007 - Project Herald Business Case to Investment Board

F. Contact details

Report author: Detective Superintendent David Imroth, MPS

For more information contact:

MPA general: 020 7202 0202
Media enquiries: 020 7202 0217/18

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