Police custody centres framework blog: February 2024
Supporting improvements in the delivery of healthcare to vulnerable people in police custody centres – Jessica Davidson MBE
Healthcare in police custody centres is a delicate balance of justice and appropriate care for the individual. As a part of a programme of work and inspections by HMICS and Healthcare Improvement Scotland (HIS), we’ve published a framework to support the work. Jessica Davidson MBE is Chair of the group that developed the framework. She explains why police custody healthcare matters and what the inspections can help to achieve.
People who find themselves in police custody centres are often not just detainees. They are also patients requiring healthcare.
They can be at their worst in terms of temper, distress, crisis, anger and vulnerability. They can be detained for murder, rape, crimes of violent destruction and dishonesty. Regardless of the crime, they are often in crisis. Perhaps experiencing complex trauma in their own lives. Perhaps with daily struggles around poor accommodation and poverty. Moreover, many have lost reasons to recover, and have often lost hope. The crimes they have committed can come with a litany of warrants, debts and jail sentences.
In fact, the police custody centre is a unique environment. It both stands alone and is intertwined with a justice system which can be complex for detainees with healthcare problems to navigate. Governance and oversight of healthcare to police custody centres was given to NHS boards and Health and Social Care Partnerships (HSCPs) across Scotland in 2014. The basic human right to healthcare became protected. Therefore, the custody centre environment in Scotland requires a balance between justice and healthcare.
In 2022, HM Inspectorate of Constabulary in Scotland (HMICS) and HIS worked jointly to undertake a baseline review. It was to establish a benchmark of current healthcare provision to people detained within police custody centres across Scotland. The aim of the review was to inform planning of future inspections of police custody centres. These would be undertaken jointly by both organisations.
The purpose behind this work is to address the problem as to why care is different across custody centres in Scotland. We were aware that there was a great deal of variation in the healthcare models delivered. We wanted to know how this translated into equity of access to healthcare.
“We were aware that there was a great deal of variation in the healthcare models delivered. We wanted to know how this translated into equity of access to healthcare.”
The next step – which we have now just completed – is the publication of a final framework. The framework sets out the foundation for how inspections of custody centres will be carried out. Alongside this, we’ve published a report on how we engaged with people with lived experience of custody centres. And a report on how the framework itself was created.
Supporting improvements in healthcare across police custody centres
Inspections uncover good practice, dedicated individuals, and excellent public service. They also reveal problems and inequalities that having a framework can help to fix. This was the central purpose of the Short Life Working Group that I was asked to chair – to understand the competing complexities. But also decide on the minimum level of practice that we wanted to see replicated meaningfully throughout Scotland.
As Chair, I wanted to co-create a framework which supported the fundamental ethics of access to good healthcare for all. This needed to be in conjunction with the upholding of human rights under law. The role of Chair is to make sure that the framework to inspect was fair, representative, equitable and fit for purpose.
“Inspectins uncover good practice, dedicated individuals, and excellent public services. They also reveal problems and inequalities that having a framework can help to fix.”
I brought to this role my experience as an adult and mental health nurse. I learned my clinical experience working in emergency fields, project, service development, working as well as chairing national work and building strategy, standards and innovation. And I brought my experience of developing Custody and Forensic Healthcare teams for many years. One of the issues that has hitherto existed and affected the equity of care in custody centres across Scotland, is that police custody centres can be left out of national data gathering exercises. These exercises lead to the commissioning of funded services. Patients who find themselves in custody can be way unhealthier with unmet needs than people of same age elsewhere. Aspects such as addiction and homelessness lead to even further morbidity and early death, which has significant impact on all of us. The information identified from inspections than help bridge this gap. It ensures that services are developed accordingly.
Steering the path to an effective framework for care
The framework is not just about the wellbeing of those detained within custody centres. Witnessing and experiencing trauma is a huge part of the healthcare delivery experience. If unsupported and misunderstood, it can lead to moral disorientation amongst healthcare professionals.
Moral distress can be caused by witnessing the moral transgressions of others. Especially when this is sustained. So the framework needed to address and protect the wellbeing of healthcare providers. It does this by being explicit in the duty of integrity of our services to people who can be regarded as ‘unpopular’ patients.
The way forward
We know that there are pockets of resistance to providing healthcare to police custody patients. The staff in Police Scotland and NHS Scotland are endlessly resilient and compassionate. But mainstream acknowledgement of custody as a referring service where patients have the same right to same day addiction prescribing, blood borne virus treatment, mental and social health services is building. But we still have a way to go.
As Chair, I am delighted this process has begun. What this translates into could save lives, solve problems, improved health for some of the poorest and most challenged people in our society. It is important to acknowledge that some people will inevitably go to prison to pay a societal debt. But it is wise also, to allow the power of healthcare to be a key intervention in the justice system. It may prevent repetition of crime that causes misery within our communities.
Jessica Davidson MBE is a Senior Clinical Forensic Charge Nurse based in the police custody and forensic examination service covering south east Scotland, and Chair of our organisation’s Police Custody Centre Healthcare Inspections Short Life Working Group.
More information
Framework to inspect healthcare provision within police custody centres