KENT POLICE CUSTODY SUITES
health needs assessment
2012
DRAFT
Stephen D Cochrane
Specialist in Public Health
April 2012
7
Stephen D Cochrane, Specialist in Public Health
24th April 2012
Acknowledgements
Kent Police
Debbie Wade, Forensic Medical Services Manager
Paula Thornton, Assistant Manager, Forensic Medical Service,
Mark Whitehouse, Assistant Manager, Forensic Medical Service,
A/DCI Matthew Long, Strategic and Risk Management - PPU
DI Ian Sandwell, Drug and Alcohol Inspector (Partnerships)
Julia Harman, Criminal Justice Support Manager, Strategic Criminal Justice Dept
Gemma Davison, Administrator, Forensic Medical Services
NHS Eastern & Coastal Kent & Other NHS Trusts
Jess Mookherjee, Public Health Consultant
Del Herridge, Public Health Information Team Manager, Kent & Medway Public Health Observatory.
Natasha Roberts, Head of Health Intelligence, Kent and Medway Public Health Observatory
Julie Tippett, Public Health Team Secretary, NHS Kent and Medway
Dr Deirdre O’Brien, Clinical lead Sexual and Reproductive Healthcare, Kent Community Health NHS Trust
Alan Stewart, Head of Community Services, Kent and Medway NHS Health & Social Care Partnership Trust
Others
Sheila Poulton, Strategic Lead for Health, Sheppey Cluster
Trudy Taylor, Head of Healthcare, Sheppey Cluster
Claire Begent, CRI DIP Service Manager
Dr Kate Andrews, Independent Consultant
Dr Tom Price, Forensic Medical Examiner & GP, Tonbridge, Kent
This Health Needs Assessment for Kent Police Custody Suites
was considered and adopted by the Police Healthcare Partnership Board on the 4th May 2012
Signed ………………………….. Signed …………………………….
Date …………………………….. Date ………………………………..
Detective Superintendent Public Health Consultant
Kent Police NHS Kent and Medway
Signed ……………………………..
Date …………………………………..
Lead Commissioner Offender Health
NHS Kent and Medway
Contents
Page No.List of Tables and Charts / 5
Executive Summary including recommendations / 7
Introduction / 9
Context / 14
Characteristics of the Custody Suites Population / 19
Substance Misuse – Drugs and Alcohol / 24
Mental Health / 30
Custody Suites Healthcare Service Provision / 35
Service Funding / 41
Stakeholder Consultations / 42
Governance arrangements and Performance & Quality Indicators 2010 / 45
Recommendations / 46
Appendices
Appendix 1 – Locality Maps – Place of Residence of detainees / 47
Appendix 2 – List of Abbreviations / 52
Appendix 3 – References / 53
List of Tables and Charts
TABLE 1 / Description, Location and Capacity of Custody Suites page 14TABLE 2 / Number of Detainees by Custody Suite and Month of Arrest page 19
TABLE 3 / Gender & Age split of all Detainees by Custody Suite page 20
TABLE 4 / Ethnicity of Detainees in Kent & Medway Custody Suites – 2011 page 20
TABLE 5 / Breakdown of ethnicity of 'detainees' in Kent & Medway Custody Suites in 2011 - with area ethnicity comparison. Comparing levels of local ethnicity with ethnicity of detainees page 21
TABLE 6 / Local authority of residence of Detainee by Custody Suite page 21
TABLE 7 / Deprivation Status* of Detainees across Kent & Medway. (Percentage of detainees from each deprivation decile page 22
TABLE 8 / Deprivation Status* of Detainees across Kent & Medway. (Percentage of detainees from each deprivation decile page 22
TABLE 9 / Average 'Arrival to Disperse' time by Custody Suite and Month (HH:MM:SS). Kent and Medway 2011 page 23
TABLE 10 / The general affects of problematic/hazardous drinking (National Addiction Centre/DH 2003) page 24
TABLE 11 / Forensic Medical Consultations that are drug or alcohol related page 27
TABLE 12 / DIP Activity in Custody Suites – High Volume Areas page 28
TABLE 13 / Numbers of Contacts and Assessments April – December 2011
page 29
TABLE 14 / Psychiatric Screening Questionnaire (PDSQ) T Scores: HMP Elmley page 31
TABLE 15 / Intelligence Wechsler Abbreviated Scale of Intelligence (WASI) Scores HMP Standford Hill page 31
TABLE 16 / Detainees presenting a mental health problem by Custody Suite 2011 (Kent Police FNP assessment) page 32
TABLE 17 / Detainees referred by a FNP for a mental health problem by Custody Suite 2011 (Kent Police FNP assessment) page 32
TABLE 18 / East Kent and Medway Police Custody Liaison and Diversion Service – April 2011 to March 2012 page 32
TABLE 19 / Ethnicity of K&M Partnership Trust Mental Health Referrals 11/12
page 33
TABLE 20 / East Kent and Medway Police Custody Liaison and Diversion Service – April 2011 to March 2012. Referrals by Presenting Problem page 33
TABLE 21 / East Kent and Medway Police Custody Liaison and Diversion Service Initial Psychiatric Outcome page 33
TABLE 22 / Primary Care FNP Provision page 36
TABLE 23 / Number of contacts with clinical staff by 'Custody Suite' and month of arrest page 37
TABLE 24 / Clinical contacts in Custody Suites, as a percentage of all detainees page 37
TABLE 25 / Detainee consultation rates per Custody Suite Clusters 2011 page 37
TABLE 26 / Average length of consultation by Forensic Nurse Practitioners page 38
TABLE 27 / Number of Forensic Nurse Practitioner consultations by time of day page 38
TABLE 28 / Number and percentage of detainees with health & well-being problems page 39
TABLE 29 / Forensic Nurse Practitioner Consultations that are drug or alcohol related page 39
TABLE 30 / Forensic Nurse Practitioner Consultations that result in a health related referral page 39
CHART 1 / Location Map – Kent Police Custody Suites page 17
CHART 2 / Simplified Police Custody Process Kent Police 2012 page 18
CHART 3 / Numbers Entering Kent Custody Suites by Month 2011 page 19
CHART 4 / Average Time detained in Custody Suite by Location page 23
CHART 5 / Graph indicating the number of Kent alcohol related arrests by month page 25
CHART 6 / Table indicating the location of Kent arrest referrals and the number of alcohol related arrests (01/04/2011 – 30/11/2011) page 26
CHART 7 / Clinical Contact by Detainees at Custody Suites 2011 page 38
Executive Summary
Introduction
This Health Needs Assessment focuses on identifying the health needs of detained persons (DPs) in Kent and Medway Police custody suites. The report was commissioned by the Kent Police Healthcare Partnership Board and is the first integrated health needs assessment undertaken in this format. It therefore serves as a reference point for future health needs assessments of this cohort and future service development.
Methods
The study was carried out using the three main methods of epidemiological, corporate and comparative health needs assessment.
The epidemiological needs assessment consisted of an analysis of various medical records, a review of clinical activity and services and a literature review for evidence of effectiveness.
The corporate needs assessment consisted of comments from the custody suites HNA Workshops and consultation with key stakeholders within the police service both from senior officer, police officers and healthcare staff including Force Medical Examiners and Forensic Nurse Practitioners.
The comparative needs assessment compared existing services and need against current healthcare standards and targets as well as other police service areas (where known).
Results
Healthcare services within custody suites are long standing and operate under challenging circumstances and recognised for delivering quality care to a demanding population.
There is a need for investing in and developing the use of information systems so that future assessment of need is based upon existing reliable and robust data, that has clear audit features, is within a clinical governance framework and also linked to quality outcomes. The current data system is clearly a robust system for use for custody suite purposes but requires a level of sophistication necessary for appropriate health and social care needs including screening and management. A bespoke healthcare solution is therefore necessary.
There needs to be improved joint working between the various health and social care services and this needs to be widened to ensure that all appropriate partners are brought to the process. There is a need to increase the number of detainees who successfully enter a mental health and/or substance misuse care pathway.
Various health and social care service Commissioners will need to assess their community services provision as a result of the new Kent Police operational model in respect to arrest and access to custody.
Gaps have been identified between baseline services and the needs identified through the health needs assessment. These form the basis of the recommendations below.
Recommendations
· Access to mental health services for all detainees should be the same across Kent and Medway to ensure equity of access. (mental health)
· Any future Kent and Medway Mental Health Needs Assessment carried out within the criminal justice system needs to include the detainee population held in police custody suites. ( mental health)
· Appropriate clinical pathways should be developed to increase the referral rates to drug, alcohol and mental health services due to poor referral to treatment rates. (substance misuse and mental health)
· Mental Health and Drug & Alcohol Commissioners should consider the implications of the Kent Police new Defendant Custody Management Policy on the ability and capacity for community based services to respond to these changes in the criminal justice system. (substance misuse and mental health)
· All parties coming into contact with detainees should be trained to deliver Alcohol Identification and Brief Advice (IBAs) interventions and if possible IBA interventions should be part of a pre release from custody protocol in line with the Government’s Alcohol Strategy. (substance misuse)
· Embed NHS Health Check Programme in police custody suites primary healthcare and offered to eligible detainees. (primary care)
· Due to little evidence of chronic disease or long term conditions in the custody suites population a clinical audit should be carried out to better understand the morbidity of detainees (primary care).
· All providers of health or social care in Police custody suites should ensure that they complete appropriate medical and other relevant information for detainee. (clinical governance)
· Provide an appropriate health screening tool preferably within a bespoke system suitable for use in the criminal justice system e.g. SystmOne as this will also ensure compliance with appropriate governance guidelines. (clinical governance)
· Provide a formal clinical governance framework including relevant parts of PACE and The Safer Detention & Handling of Persons in police custody. (clinical governance)
· As required by clinical governance FMEs and FNPs need to access NHS or other appropriate clinical training as well as appropriate appraisal. (clinical governance)
· Streamline communication between custody suites and the wider NHS by using NHS.net accounts in all clinical exchange. (clinical governance)
· Given that nKPM commenced in late 2011 this HNA should be reviewed every 12 months and carried out in full every 3 years in line with Prison HNAs.
Introduction
This Health Needs Assessment presents an overview of the health needs of detainees primarily within the custody suites of Kent Police. It does not explores the needs of offenders who are in contact with community criminal justice agencies, namely the National Probation Service, Youth Offending Teams, Integrated Offender Management (IOM) and those in prison or immigration removal centres across Kent and Medway. This latter population health care need is available on the Kent and Medway Public Health Observatory site (http://www.kmpho.nhs.uk/population-groups/prisoners/). It does also not cover SARC services which are subject to separate assessment and commissioning arrangements.
Data has been gathered to inform this document via Kent Police, Kent Forensic Medical Services, Kent and Medway NHS Health and Social Care Partnership Trust, Kent and Medway DAAT Teams, NHS Kent and Medway Trusts (Cluster) and Local Authorities. A range of issues have been identified in this document and 13 recommendations have been made for service improvement and development.
The benefits of completing a robust health needs assessment will; enable improved partnership working between the police and NHS, more informed and improved identification of the clinical need of individuals coming into contact with criminal justice services including detention in police custody suites, improved and integrated pathways between the Criminal Justice System and the wider health and social care agencies and the opportunity for more appropriate staff training and understanding of the needs of offenders, particularly those with mental health problems and those with a learning disability.
Background
In 2009 Lord Bradley published a review into how the Criminal Justice System (CJS) interacted with those suffering with mental ill health problems and those with a learning disability, the Healthy Children, Safer Communities report also published in December of 2009 identified the needs of children and young people in contact with CJS. The needs of women had been identified in the 2007 Baroness Corston review of women with particular vulnerabilities in the CJS and were again referenced in the Bradley Report. The recommendations made in these reports were accepted by the previous government under the “Improving Health, Supporting Justice” delivery plan and have now been adopted by the coalition government.
Nationally governance of the deliverables is now via the National Health and Criminal Justice Board which has cross government representation from the Department of Health (DH), Ministry of Justice (MoJ), Home Office (HO), National Offender Management Service (NOMS) and Association of Chief Police Officers (ACPO).
On the basis of Lord Bradley’s recommendations, the Board currently manages two deliverables that affect the way that the NHS interacts with policing, namely:
· The transfer of commissioning, budgetary responsibility and accountability for police detainee healthcare, forensic provision and Sexual Assault Referral Centres (SARC) to the NHS by April 2013.
· The development of mental health criminal justice liaison and diversion schemes.
Both the Minister for Social Care, (DH) and the Policing Minister, (HO) have now signed off a joint submission detailing the benefits and trajectory of the transfer, which is inclusive of an Early Adopter programme, for which Lancashire Police has been accepted.
It is important to point out that this is a transfer of commissioning, as opposed to a transfer of provision. A commissioner in conjunction with the Police Healthcare Partnership Board will make an assessment in the transfer process as to who the best provider may be based upon cost, quality and scope of provision. Such a decision would need sign off by both the NHS and the Police.