Improvements for the Future

The interviews discussed aspects of the pilot and healthcare in the custody unit more generally, which some participants thought could be improved for the future. The following section suggested improvements for the pilot, and the following section focuses on the custody unit.

5.10.1 Role and Remit

It was hoped that through this pilot, a clear picture of how nurses could support the custody unit and the role of the forensic physicians would emerge. In terms of the role of the pilot staff, there was agreement from those interviewed, that the main aim was still to provide a way of identifying those entering the custody unit who have a mental health or physical health need and providing appropriate signposting to support for these individuals – whether this is for physical/mental health or social services issues.

The role of the pilot staff was also reported to be important for further consideration, with a clearly defined remit. Some additional elements to their current role were suggested, for example being able to ‘administer medication’ and gaining a fuller understanding of the fit between the forensic physicians and the pilot team, i.e. identifying which lower level tasks can become the responsibility of the pilot staff. One respondent reported that this should be more of a ‘triage process’ within custody, with staff treating minor illnesses or ailments.

It was suggested, by one stakeholder, that consideration should be given to the level of staffing for any future service. Would more staff make it possible to screen everyone entering custody? Is this necessary for a future service? These were some of the considerations posed by this interviewee.

5.10.2 Communication about the pilot – its aims and remit

The need for a clear outline of the role of the pilot and its remit was discussed by some interviewed. This was the case as the pilot was initially launched and following its extension, when there was a further opportunity to restate the aims.

‘… my goal would be that offender’s needs, as they come into custody, are identified, be they mental or health or emotional wellbeing needs, physical health needs, I include autism and things like that in there, or social housing benefit or drugs or alcohol are all identified and that person is actually connected in.’

The need for improved communication was also discussed as a key for the pilot should it develop further, in terms of presenting the service to a wider range of support services and providing information about its function, aims and remit. As one stakeholder stated, ‘if you want people to come on board just to increase their understanding, you know,

you’d achieve that even if just by sharing a bit of information…’. Consideration should

therefore be given to sharing the work of the pilot more widely, specifically in relation to working hours, staff roles and backgrounds etc. In this way a better understanding of the purpose of the pilot can be disseminated and opportunities for team collaborations identified.

The actual role of the pilot needs to be confirmed so that staff clearly understand what support they can provide to forensic physicians, and what health needs they can specifically support.

5.10.3 Developing collaboration across services

As the pilot develops further, it was suggested that stronger communication processes needed to be established to maintain and strengthen good links with external services so that staff are aware of the full range of services which they can signpost for detainees. One service provider talked about wanting to know more about the pilot and of ensuring that they were not ‘forgotten’ as a service.

It was suggested that a database of organisations with key contacts could be developed to ensure that all appropriate services are linked into the pilot.

‘… the pilot in custody’s been really good and it’s still a learning curve for all of us but I think clear definition of what we do and we don’t do… would be really helpful.’

‘… but key to that is that service works, is effective, is known by all partners because I think, I have to say that is a real challenge, magistrates and judges and getting all that information out, but that information gets to them as well and everybody’s familiar with that…’

‘I think what we’d like to see is perhaps if someone’s got a bump on the head, you know, do they need a steristrip or do they need to go to hospital which takes the onus off of the doctors, who as I say can be otherwise committed for some hours.’

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A collaborative approach was also seen as a key to the future success of this pilot, through joint working between services. The use of a single database of information for example was suggested as a way of supporting this sharing of information/knowledge. One interviewee was concerned that the different teams should not be working in isolation, but that there should be a connection and cross working between teams. While another suggested that ‘inter-agency training’ would help to provide a ‘better coordinated … approach to patient care’.

5.10.4 Physical space and equipment

The provision of a suitable environment for health assessments and appropriate equipment has already been discussed as areas for consideration in the future. Duplication of equipment for pilot staff and forensic physicians was thought could improve the running of the pilot, as well as practical elements such as a clock in each room, new equipment such as a pressure machine and a thermometer, and clear responsibility for upkeep of equipment and supplies.

One interviewee also spoke about the potential to complete the screening forms electronically to ease the pressures of writing up. It was suggested that an iPad or other electrical devise would be valuable in supporting staff to undertake screenings more effectively and in a more timely manner.

5.10.5 Provision of on-going support

Another area which was suggested where the pilot could develop, was in supporting detainees to access support and in seeing ‘that end result’ outside of the custody unit, perhaps through more in-depth support or further advice. Primarily, it was thought that ensuring information about people’s mental health issues is actually being picked up by other agencies or through the criminal justice system was thought to be a key area which the pilot could take up and that detainees access the support suggested, thus providing a greater continuity of care.

‘A service that is integrated into the core of the NHS enabling direct exchange of information between custodial medicine and mental health services, GP, hospitals etc.’

‘Mental health worker having a dedicated clinical room and with access to appropriate IT.’

While initial follow up is being carried out by the pilot team, it was thought there could be scope for a more involved, longer-term follow up to ensure that once identified as being at risk, individuals are not lost in the system, but are properly supported.

It was also suggested that a timeframe within which a person is held in custody and when support is accessed should be considered so that people are processed in a timely manner and to ‘get things moving’.

The provision of additional services by the pilot staff was also discussed, with one interviewee suggesting the team should be able to provide cognitive behavioural therapy (CBT) to detainees or ‘short term interventions with people, sometimes around

education’ (in relation to medication for example). It was also suggested that this longer

term intervention should be delivered outside of the custody unit in a more neutral environment. However, this would be an extension to the role and remit of the pilot, but could be considered in the future.

‘… but it was one of the things of the pilot, is getting the information down the system…’

‘… making sure people get the appropriate care and I mean we can all give people scripts and give them an appointment to go to but a lot of these people don’t so I think there needs to be much more structured interventions for people on release with mental health problems.’

‘… then they can be referred on because if you let these people go, especially substance misuse and, you know, repeat offenders, if you let these people go, you lose them again to services and they can’t get the support.’

‘… it is, you know, have that opportunity there and then within a set timeline, get rid of them into either custody straight away or clinical assessment… or social care or family or something, … and get things moving.’

‘… it might involve us doing the mental health assessments as well, so getting a fuller assessment of people, but it might also involve us doing some follow-up with them as well so getting them to see people outside of custody and just looking at what they can do. I mean for me, for me there is room to do sort of [inaudible] focus there and there is room to do a bit of CBT here and there, you know, medication advice, illness advice, there’s room to have people back…’

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It was also suggest that a more in-depth assessment, for those individuals who are presenting in custody regularly, could take place in order to develop a more holistic understanding of the issues contributing to the individual’s criminal behaviour, rather than the ‘snapshot’ currently being provided by the pilot.