Partnership working between A&E, the police and custody healthcare

Summary

Craig Russo is an Operational Manager at Leeds Community Healthcare NHS Trust. In this blog, he tells us about a recent project he delivered in partnership with Accident and Emergency (A&E) services, the police and custody healthcare. Craig talks about the safety concerns that led them to take action and the positive impact they have seen so far. 

Content

This project responded to concerns that had been repeatedly highlighted through incident reports, feedback from staff and patients, and formal investigations conducted by myself. 

The concerns focused around:

• Patient safety and quality of care with regards to discharges from A&E into police custody.
• Patients being brought into a police custody healthcare setting who required the specialist care of A&E.
• Patients in police custody being discharged from A&E without appropriate care given to them, which put them at high risk of deterioration or safety implications.
• NHS services and the police bringing in patients to a police custody healthcare setting, who had been arrested and were requiring urgent care. 

Underlying issues

Training and communication barriers

Firstly, the A&E staff had very little training on detainee patients, who in their own right often present as being very complex. Long-term difficulties in communication between A&E, Humberside Police and Custody NHS services also existed and this didn’t help with knowledge sharing.

Discharge policies not fit for purpose

Patients were often discharged without a thorough assessment, care plans, records or handovers. The policies, protocols, pathways and records were not fit for purpose. This caused major risks to patients' safety and care, and we had a number of patients who were discharged requiring urgent care and being returned to A&E. This put a strain on all services, increased costs, and damaged the patient journey.

Poor risk assessment

It had been highlighted that some police officers were not doing a holistic, thorough assessment of the patient when arresting them. Often, they were bringing them to police custody NHS services, which are not designed to conduct urgent care, instead of taking them to A&E for appropriate treatment. Delaying their care was often life-threatening.

Working in partnership for patient safety

Previously there had been lots of challenges. We had all been using different systems, no clear pathways, there was very poor communication and reduced accountability. Partnership working did not exist.

We looked at creating a partnership between Hull Trust, Lincolnshire and Goole Trust, Leeds Community Healthcare, and Humberside Police that could directly influence and improve patient care and standards. We wanted to share knowledge and expertise between all organisations and reduce the number of serious incidents. We wanted to do something that had never been done before.

Patient care and safety was the focus but there were other areas we wanted to improve including:

• care pathways
• documentation
• costs
• staff time
• the patient journey
• training.

Impact

This project is unique and innovative, covering both the NHS and criminal justice system.  It is such a specialist area of medical care that no one had thought to review and improve it. We’ve achieved so much by working in partnership.

Key outputs:

• Introduction of a discharge safety checklist designed to support safety in police custody care - improving accountability, standards, and providing a handover to the police and NHS staff (see document attached to the bottom of this blog).
• Bespoke training rolled out to Hull NHS Trust A&E, to upskill and teach staff about police custody and patients in custody.
• New pathways integrated into the care of patients.

Key outcomes:

• Improved communication between three trusts and the police.
• Reduced number of incidents of poor patient care or safety (serious incident reports and investigations).
• Improved patient journey.
• Increased knowledge of patients in custody among NHS staff.
• Reduced wrong area referrals.
• Improvement in the wellbeing of patients.
• Reduced wastage of staff time.
• Reduced costs.

The bespoke training is also now part of the corporate induction, delivered by Leeds Community Healthcare staff. Feedback from patients and staff has been very positive. It is now the ‘gold standard’ for Humberside Police force and adopted by A&E’s in multiple areas.

"The training has been really well received in A&E it has upskilled staff and increased their knowledge of this specialist area" (healthcare professional).

Final reflections

There has been a massive reduction in serious incidents reports and investigations. Staff now receive training that focuses specifically on patients in custody. Patients are treated with dignity and have become more cooperative.

This project has been an outstanding success and has been put forward for parliamentary awards, and others. It has been recognised by professionals, trusts and the police as being extraordinary and innovative work which has improved safety, productivity, learning and reduced costs.

This approach is going to be implemented in South Yorkshire and West Yorkshire Police custody. York NHS trust has also expressed interest in learning from our project and implementing similar.

It has been an amazing project, underpinned by partnership working.

If you would like to find out more about the project, you can get in touch with Craig at craig.russo@nhs.net

Do you have a project to share?

Have you been involved in a project that has improved patient safety? Could you share your insights and learning to help others do the same? You can comment below (sign up first, for free), or get in touch with the editorial team at content@pslhub.org

Discharge of Patient from the Emergency Department into.docx

About the Author

Craig Russo is an Operational Manager at Leeds Community Healthcare NHS Trust. In 2024, Craig was awarded a British Empire Medal for services to mental health nursing. He was also highly commended by parliament in the People’s Champion of the Year Award 2024.