I would like to bring you up to date with our advocacy campaign for better healthcare in police custody. We have been able to discuss the ideas with leading stakeholders in police, healthcare and in Parliament, and I am very grateful to all those who have met with us. I am delighted to say that there is universal agreement on the need for a better system and the benefits of better sharing of health information. The discussion has turned on the best way to deliver those benefits – I believe the arguments on quality, cost and ease of implementation point towards a single national system.
To recap, the best way to organize healthcare in police custody in England and Wales has been a concern of governments for over a decade. Custody healthcare is currently commissioned by individual police forces, creating the risk that healthcare information will not be shared between forces (and between forces and other parts of the criminal justice system). The Bradley Report (2009) pointed out that “police custody is now the only major stage in the criminal justice system where primary NHS-commissioned care is not available”. It recommended that the NHS should take on responsibility, and the Angiolini Report strongly supported that view in 2017. Improving police custody is still an urgent need: in the last two years, 25 per cent of coroners’ reports of deaths in police custody have referred to difficulties in sharing or collecting health information. In total 23 people died in police custody in 2022-23.
In our meetings, it has been great to see that stakeholders in police and health see real benefit in improving the sharing of healthcare information. They would judge a new system on its quality, its cost-effectiveness, and its ease of implementation. We have discussed three options: the current system; a regional model; and a single national system.
Some have supported the current model on the grounds that it provides a choice of healthcare information systems for the commissioners in the 42 forces. Competition between providers will lead to better products and competition is the main advantage of the current model. Its disadvantages are the difficulty of sharing information between different systems, as described above, and the cost of duplicated competitions and contracting across the 42 forces. It would be very difficult to implement a joined-up service between 42 police forces and the rest of the criminal justice system.
Others have suggested a regional model, with forces sharing data on a regional basis. This would preserve some competition between forces and would be easier to implement. But there would remain difficulties in sharing information between the regional groups, and the rest of the criminal justice system. There would also be duplicated costs of competitions and contracting.
A single national model would still offer the benefits of competition, since companies would compete to provide the national system. It would also deliver information sharing between forces and would be much easier to integrate with the rest of the criminal justice system. It would also save costs in competitions and contracting.
The evidence points to a single national system. For those concerned about the creation of a single national provider, there would still be strong competition between providers, and choice for the commissioner, when the national contract was let and in future competitions. A well-written contract and effective contract management would enable the commissioner to work with the provider to deliver quality improvements. The current prison clinical system has been a proven success over the last ten years in successfully sharing patients’ clinical data between sites.
As I say, it has been fantastic to discover the shared wish for improved outcomes in custody healthcare among senior stakeholders. I look forward to continuing to explore the best way forward this year.
