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What the NHS can learn from local authorities about commissioning |
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Sainsbury Centre for Mental Health; and |
Rob Fitzpatrick |
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Medical provision in police custody in England and Wales is directly commissioned by 43 local police forces, almost universally without the involvement of PCTs. Within police custody suites, healthcare is conducted under the supervision of forensic medical examiners (FMEs), responsible for assessing whether a detainee is fit for police questioning and ensuring that appropriate care is available while detained. In addition to the FMEs’ services, some custody suites have access to assessment services by general and mental health nurses and other mental health professionals, either through direct commissioning by the police, or in partnership with local health and social care commissioners and agencies. Additionally, each custody suite has access to drug arrest and referral services funded through the Home Office sponsored Drug Interventions Programme. Current arrangements A recent report produced by the Sainsbury Centre for Mental Health (Briefing 36: The Police and Mental Health, 2008) describes some gaps arising from existing commissioning. With (generally) only limited links between the police’s own force-level commissioning of services and wider networks of health and social care commissioners, there is often a significant lack of connection between the work of police officers and community-based health services. This results in poor communication on the ground and limited opportunities to divert individuals with health needs to community-based services. This is particularly the case for socially excluded people with common mental health problems and complex needs who, in the absence of appropriate support, frequently end up coming to police attention by default. The Dorset model Following the early termination by the police of an earlier PFI contract, Dorset PCT has started working in partnership with Dorset Constabulary to re-commission healthcare services, including mental health services, in police custody. This arrangement covers provision in three main stations which will have 24-hour staffed medical and nursing input, and a a tele-link system of access to medical staff for a number of smaller, local stations. New governance, steering and review structures have been established involving the PCT, the police and the contracted provider of services. An independent academic evaluation of this initiative, commissioned by the Home Office, is under way. The success of this initiative will depend upon co-operation between staff from agencies with little experience of each other. Much input is being invested in the development of close working links between the PCT, the police and practitioners at both strategic and operational levels. Future opportunities The Dorset initiative provides an example of a model for joint commissioning between the police and PCTs. Once established, it could open the door to more effective joint provision of services. For example, it would enable PCT commissioners with a criminal justice remit to consider interventions across the whole criminal justice system, involving the police, courts, prison and other community interventions, and to engage more strategically via Local Area Agreements. Such an arrangement could also lead to operational improvements: improved opportunities for diversion, improved training becoming available to staff across the system in health and social care issues and more equitable access of care and support to socially excluded individuals with complex needs.
rob.fitzpatrick@scmh.org.uk carole.lawrence-parr@dorset-pct.nhs.uk |
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Dorset PCT |
Carole Lawrence-Parr |