CHAPTER 1
Introduction to Police Custody

Matthew Peel1, Jennie Smith2, Vanessa Webb3,, and Margaret Bannerman3

1 Leeds Community Healthcare NHS Trust, Leeds, UK & UK Association of Forensic Nurses and Paramedics

2 Mitie Care and Custody Health Ltd, London, UK & UK Association of Forensic Nurses and Paramedics

3 Nurture Health and Care Ltd, Norwich, UK

AIM

The aim of this introductory chapter is to provide a foundational understanding of the multifaceted realm of police custody healthcare in the United Kingdom. This will include the current state of forensic healthcare, the role of the healthcare professional, including training and induction. A broad overview of police custody, including the purpose, standards, individuals working in custody and the relevant legislations, will be provided.

LEARNING OUTCOMES

After reading this chapter, you will be able to:

• Understand the current landscape and varying levels of consensus in forensic healthcare within the United Kingdom
• Describe the structural and operational differences in police custody across the devolved nations
• Identify the key demographics and vulnerabilities of individuals detained in police custody

SELF-ASSESSMENT

1. What are the primary roles and responsibilities of HCPs in police custody?
2. Who are the typical detained individuals in police custody and what are their common demographics and vulnerabilities?
3. What standards of care and professional conduct are expected from HCPs working in police custody?

INTRODUCTION

Forensic science is guided by Locard's principle: 'Every contact leaves a trace' (Locard 1934). However, this ethos extends beyond physical evidence to the compassionate care that healthcare professionals (HCPs) provide to those detained, often in their most vulnerable moments. HCPs must strive to positively impact individuals through respect, dignity and hope. This approach blends assessment, examination and forensic strategy, along with advice, treatment, brief interventions and signposting, aiming to leave a beneficial impact on those they encounter.

This chapter delves into the unique challenges of police custody healthcare, where HCPs work with limited evidence-based guidance to prioritise patient safety and well-being. It addresses the diversity in practices, the absence of consensus in certain areas and the crucial role of risk assessment. It emphasises the need to balance healthcare needs and human rights with police procedures; this introduction sets the stage for exploring the dynamic and ethical landscape of police custody healthcare.

CONSENSUS

Within police custody, there is a scarcity of comprehensive, evidence-based guidelines, providing a unique challenge for healthcare providers to navigate this uncertain terrain with the patient's safety and best interests, as their guiding principle. This has given rise to a spectrum of practices, each supported by its own evidence, albeit limited and characterised by distinct advantages and potential risks. The variety in clinical approaches reflects not a shortcoming but rather the complex nature of forensic healthcare, where clinical judgment intertwines intricately with the dynamic interface of police procedures and healthcare provisions. These practices are informed by a multifaceted interplay of factors. Recognising these variations, this text identifies areas where there is no consensus in practice, offering a comprehensive view of the diverse methodologies currently in use. For practitioners keen on delving deeper into the development of standardised practices and understanding how to bridge professional opinions, the National Institute of Clinical Excellence (NICE) provides invaluable resources, particularly its guidelines on managing differences in professional opinion.

FORENSIC HEALTHCARE PRACTITIONERS

Forensic healthcare practitioner (FHP) is the umbrella term for HCPs working in forensic healthcare settings (police custody and sexual assault referral centres), typically doctors, nurses, paramedics and midwives. They are distinct from those working in forensic mental health settings.1 Within this text, we will refer to FHPs as HCPs; however, both titles should be considered synonymous. In police custody, FHPs are more commonly referred to as:

• Custody healthcare practitioner or professional
• Custody nurse/paramedic
• Custody nurse/paramedic practitioner
• Forensic nurse/paramedic examiner

HCPs work at the front door of the criminal justice system, at an intersection between health, justice and forensics, with a dual patient and medico-legal responsibility. For nurses and paramedics, this involves working at an advanced practice level with a high degree of autonomy and complex decision-making (National Health Service 2017).

They have medico-legal responsibilities, such as advising on fitness to interview. In addition, they are responsible for clinically examining and treating individuals presenting with undifferentiated and undiagnosed injuries or illnesses. They also undertake forensic examinations and sampling, providing written statements and oral testimony in court.

EDUCATION AND TRAINING

While HCPs bring with them several years of post-registration clinical experience, knowledge and skills, they still require thorough induction, supervision and support. Figure 1.1 demonstrates a path from novice to expert2 (Benner 1984). As HCPs come from a wide range of clinical backgrounds and specialities, induction training programmes should be flexible to meet individual needs.

Induction

The UK Association of Forensic Nurse and Paramedics (UKAFNP) has developed standards for induction for healthcare providers to deliver locally, see Box 1.1.

Ongoing Training

Ongoing training and development are essential following induction across all healthcare settings and forensic healthcare is no different. Ongoing training should include both in-house training and external training.

Post-graduate Education (and Exams)

Several stand-alone master's level post-graduate modules will be of interest to HCPs; these include:

• Independent prescribing
• Minor illness
• Minor injuries
• Mental health
• Substance misuse
• Human rights
• Law

Alternatively, HCPs may undertake a master's level post-graduate qualification.

Advanced forensic practice (PgCert, PgDip, MSc)

An advanced forensic practice programme,3 aligned to the UKAFNP ASET award (advanced standards in education and training), is available, including a taught and assessed clinical aspect evidenced by completing a competency document and taught and practical assessments of forensic science knowledge, practice and legal skills, including statement writing and providing oral evidence. These courses are a blend of forensics and advanced clinical practice. It is important to note that the requirements for 'advanced practice' differ across the different countries.

FIGURE 1.1 Novice to expert.

BOX 1.1 STANDARD FOR INDUCTION

• Overview of organisation, including local mandatory and statutory training
• Governance, patient safety, the duty of candour, reflection and equality, diversity and inclusion
• Resuscitation
• Medicines management, including patient group directions or non-medical prescribing
• Children's Act, Mental Capacity Act and consent
• Mental Health Act, mental state examinations, including risk to self and others
• Level 3 safeguarding children and adults; in addition to PREVENT and female genital mutilation
• GDPR, confidentiality and records management
• Forensic strategy, forensic sampling (including toxicology), chain of evidence
• Ongoing continuity of care

Source: Adapted from UKAFNP (2023).

Advanced clinical practice (PgCert, PgDip, MSc)

Most universities offer advanced clinical practice programmes. Most programmes are generic, including a taught element and practical examination.

Licentiate of the Faculty of Forensic & Legal Medicine (FFLM)

The licentiate is an examination and competency assessment:

• Part 1: A three-hour theoretical examination of medico-legal and clinical practice, tested by a single best-answer paper
• Part 2: Clinical competency assessment, tested by a 14-station Objective Structured Clinical Examination (OSCE) and a short answer question paper

Completing all the elements may entitle the use of the post-nominals LFFLM.4

Diploma of Legal Medicine

The Diploma of Legal Medicine (DLM) is a stand-alone examination offered by the FFLM consisting of a three-hour examination with 150 best-of-five multiple-choice questions.

ABOUT POLICE CUSTODY HEALTHCARE

The healthcare provided in custody settings is a critical welfare component, ensuring individuals have timely access to physical and mental health assessments and treatments. This...