Scotland - SONAR CMS

In our last blog, we looked at the arguments for better healthcare in police custody in England and Wales. But – writing as a Scot, living in Glasgow – those countries are not the whole story. Scotland has its own challenges and its own reasons for considering ideas such as SONAR.

In January 2023, the key Scottish regulators for healthcare and police (Healthcare Improvement Scotland and His Majesty’s Inspectorate for Constabulary in Scotland) came together for the first time to review standards of healthcare in Scottish police custody.

The Scottish environment makes effective healthcare in police custody all the more important. Sadly, as the review highlighted, “drug deaths in Scotland are the highest in Europe with Scotland’s drug misuse rate currently 3.7 times that of the UK as a whole and higher than any European country”. This matters because people with psychiatric illnesses and psychotic disorders run a higher risk of police arrests compared to the general population. As a result, the inspectorate wanted healthcare teams in Scottish custody centres to “maximise opportunities to provide timely interventions to help improve health outcomes for people in their care”.

The inspectorate found a wide range of variation in the basic task of providing access to healthcare in custody. People in custody suites saw different types of healthcare professional depending on their location. They were seen at differing speeds, with targets for healthcare access varying between one and four hours.

Most relevant to SONAR, there was significant concern about the capturing and reporting of healthcare data. The Scottish report concluded:

“There was a recognition that improvement is needed in how services capture and report on healthcare data and key performance indicators in the context of police custody. There was consensus across all NHS Scotland boards that the current electronic system for recording healthcare data (Adastra) is not fit for purpose and does not support the comparison of clinical data nor enable national reporting.”

Looking more widely across the criminal justice system, inspection reports for Scottish prisons have also raised concerns over consistent provision of healthcare. The recent inspection reports for HMP Kilmarnock and HMP Edinburgh both reported concerns over accurate and timely provision of medication to prisoners.

SONAR and Police Scotland Custody

Following the report, Healthcare Improvement Scotland published a new draft framework for future inspections of police custody. It included several criteria for effective recording of healthcare information:

“Each patient seen by healthcare staff has a clinical record containing an up-to-date assessment.”

“Any contact with a healthcare practitioner is recorded on Police Scotland’s electronic custody system and a record made of any medication provided.”

These capabilities are at the heart of the SONAR case management system for police custody (SONAR Custody). SONAR has purpose-built screens for data entry, enabling the accurate and consistent recording of healthcare data, including medication. Since it can be accessed online, authorised staff can read healthcare data wherever is most convenient, from a healthcare professional’s medical room to a desktop PC in a prison.

SONAR also produces real time data to enable managers to improve the quality of service.

We look forward to joining the debate on the improvement of healthcare in criminal justice in every part of the UK.

From Belfast to Liverpool – Collaboration and Coming Together

Huge thanks to our team this week for organising our successful sponsorship of the 10th annual health and justice conference in Belfast – Steven, Hannah, Jason and Mike all going above and beyond in Belfast. And an even bigger thank you to Graham, Sean, Chris, Russell and Re-an for holding the fort back in Chelmsford.

SONAR CMS also attended the Labour Party conference in Liverpool, likely the last party conference before the UK general election.

It was fantastic to see the interest in SONAR and we look forward to following up with many new friends both in the UK and Ireland.

What was striking was the common themes in the discussion in both Belfast and Liverpool.

The theme of the Belfast event was “building bridges”. The keynote speakers emphasised the importance on collaboration between health and justice and all their constituent agencies. Professor Nicola Ranger, Director of Nursing at the Royal College of Nursing, said that she had sought to challenge siloed working throughout her career. She said that health and justice teams should have “one purpose, one goal: the people we are looking after”.

Dr Mark Juniper, lead clinical co-ordinator (medicine) of the National Confidential Enquiry into Patient Outcome and Death, described how better record-keeping and medicines management were linked to reductions in drug-related deaths in prisons. Dame Carol Black, leader of several reviews of drugs policy in the UK, explained that only a joined-up effort between health and justice departments in government could enable better treatment.

Across the Irish Sea, Sir Keir Starmer, Labour leader, said that his goal was to make government “joined-up” as well as “dynamic” and “strategic”. Wes Streeting, shadow health secretary, said that a “modern” NHS should be judged on how it prevents people from suffering ill health and harm.

In my presentation in Belfast, I argued that SONAR will deliver exactly this vision of joined-up health and criminal justice. It’s the reason why the individual modules of SONAR, from police custody to prisons to release, to GPIT are all part of the same healthcare information system.

I also said that I don’t have all the answers. My hope is that the health and criminal justice community can help us design the system that best meets their needs – all supported by joined-up commissioning.

Introducing the Belfast conference, Dr Caroline Watson, Chair of the Secure Environments Group of the Royal College of General Practitioners, said that the meeting should set a “foundation of hope” at a time when health and justice are under such pressure.

The wish to collaborate and to come together seems to me a great foundation on which to build.

John White

Founder and CEO

Responding to the annual IPOC report on deaths in Police Custody

On 28 July, the latest annual statistics on deaths in police custody generated headline news. The figures, collected by the Independent Office for Police Conduct (IOPC), showed that 23 people died in police custody in 2022-23, much higher than the recent trend.

Table: Deaths in or following Police Custody

Source: IOPC, 28 July 2023

The IOPC’s acting director general, Tom Whiting, said: “Sadly, we have seen a significant rise this year in the number of deaths in or following police custody, up to 23 from 11, and the highest figure recorded for five years. While last year’s figure was particularly low, the fact we have seen a sharp reverse is concerning and raises challenges which spread well beyond policing.”

Vulnerability due to mental health

As in recent years, the majority of cases were connected to mental health and use of alcohol and drugs:

• Thirteen of 23 people who died in or following police custody had mental health concerns.
  

• Twenty-one people who died in or following police custody had links to drugs and/or alcohol.
  

• Almost two-thirds (55) of those who died following other police contact were reported to have mental health concerns.
  

• A similar proportion (55) were reported to be intoxicated with drugs and/or alcohol at the time of the incident, or it featured heavily in their lifestyle.
  

• Sixteen fatalities following other police contact related to concern about a person’s risk of self-harm, suicide, or their mental health. A further twelve people were reported to the police as missing, with a specific risk of self-harm or suicide.

Risk of ineffective collection and sharing healthcare information

We can put the IOPC data together with evidence collected by other authorities. The importance of effective information on healthcare in police custody is clear.

There have been 20 reports from coroners, for example on police related deaths since October 2021. Of these, coroners raised concerns over poor recording or sharing of health information in five cases.

NHS England publishes independent investigation reports to establish what lessons are to be learned from a case of homicide, suicide or serious harm. A key theme of concern is inadequate handovers between agencies, based on incomplete healthcare information.

The police and prisons inspectorates carry out regular inspections of police custody suites. There were 10 in 2022 and 2021. In seven of the 10 cases, the inspectorates raise concern over the transfer of information between custody and detention officers.

Improving outcomes – SONAR and Right Care, Right Person

SONAR is specifically designed to address these concerns and so to improve health outcomes. It can connect healthcare information in police custody both to NHS data and to other areas of the criminal justice system. It aims not only to improve data collection but also to remove the problems of transition and handovers.

The best way to implement SONAR would be for NHS England to commission a single electronic case management system across all 42 police forces, using the same procurement framework as those currently used for general practice and health and criminal justice (GP IT Technical Innovation Framework (TIF) and Health & Justice Information Services, HJIS2). This would integrate health information across the forces and open the door to shared information across health and justice.

Tom Whiting also emphasised the importance of providing effective mental health support for vulnerable people. The IOPC will monitor the Right Care, Right Person scheme, by which people with mental health needs will be responded by mental health professionals rather than police officers. The scheme was developed by Humberside Police and is now being rolled out nationwide.

Conclusion

This year’s statistics were a shock to all those concerned with improving healthcare in justice settings. Let’s hope they can be a catalyst for a better way forward.

John White

Founder and CEO