The Faculty of Forensic and Legal Medicine is committed to raising the standards of healthcare to detainees in police custody and fully supports the introduction of a multi-professional approach in order to achieve this aim. Bond and colleagues have undertaken research ‘to examine the operational impact of a police custody nursing service on healthcare delivery in one police service in the north of England’ and their findings are potentially important.
The study raises a number of specific and more general issues. The authors found that ‘in comparison to the traditional service, nurses demonstrated faster response times, comparable consultation times, and were perceived by custody staff as more approachable than their medical colleagues in providing handover information’. Yet we note that they state ‘for legal and security reasons it was not possible to analyse clinical consultation times. However, it was possible to analyse the duration of time taken by a clinician at the police station to complete a single consultation’. This is somewhat confusing, as if ‘clinical consultation times’ could not be analysed how can a conclusion about ‘comparable consultation times’ be achieved?
The study compared a doctor-only service with one provided by a combination of nurses and doctors. The only significant improvement in performance indicators was an apparent reduction in the response time provided by nurses but this was rendered meaningless by the lack of any comparison between the manpower resources available under the two different systems and their comparative cost. Response times, in themselves, provide no information about the quality or appropriateness of healthcare provided and, given that 34·5% of detainees seen by nurses were referred on to doctors, the actual time to achieve the desired healthcare intervention may have been much longer under this system.
It should be recognised that, although response times and consultation times are easily measurable (which is no doubt why they have become important to policy makers), these times in isolation have little or no relevance to the crucially important issues of whether a longer average response time has any adverse effect on the healthcare of detainees or results in any delays to police procedures. These are matters that were not addressed in the study.
Likewise it is a pity (although we recognise not a part of the study design or aims) that the authors did not seek to address in anyway the type of consultation undertaken; the clinical findings; the outcome of the consultation; and the opinion of the examinee. These problems relate in part to the retrospective nature of the study design and in part to the researchers’ lack of access to the clinically relevant data which is the essence of healthcare in police custody.
The Faculty is working with partners to develop key performance indicators that can reliably assess the quality of healthcare provided to detainees and hopes that such indicators will provide the evidence base to properly support an expansion of multi-professional clinical team working in police custody. We believe that the authors are correct in their assertion that ‘nurses can assist FMEs by screening the need for a doctor to be called out to a police station and could help prioritise the clinical needs of detainees’. Prospective studies which explore the actual healthcare needs of those in police custody and relate those to service provision by multi-professional teams (as in any other area of medicine and nursing) are the most appropriate ways of determining the best options for an extremely vulnerable patient group.