Above: A PSNI Custody Inspector and a nurse from Belfast Trust inside the Custody Suite at Musgrave PSNI Station. (Right): Professor Charlotte McArdle, Chief Nursing Officer and (at right) PSNI Head of Reducing Offending and Safer Custody, Una Williamson.
PSNI custody healthcare in Northern Ireland is undergoing a transformation with a shift towards a principally nurse-led service on the justice system’s frontline.
The first phase of the new embedded service, costing approximately £500,000, was implemented at Musgrave Station in October 2018 and involves PSNI, the Department of Health and the Department of Justice in partnership with the Public Health Agency.
PSNI has a legal requirement to provide healthcare in custody. Specially trained Custody Nurse Practitioners (CNPs) from Belfast Health and Social Care Trust now work as part of the custody team at Musgrave Station. The care and skills brought by CNPs adds to the safer detention of vulnerable people in police custody. Mental Health nurses have also been recruited.
PSNI Head of Reducing Offending and Safer Custody, Una Williamson said the new service at Musgrave Station – where there are around 1,000 detentions per month - is working extremely well and said: “PSNI envisage the nurse-led custody healthcare model to be implemented, on a phased basis, to PSNI’s other eight custody suites by September 2020.
“Prior to the service’s implementation at Musgrave Station last year, custody healthcare at the 50-cell suite was physician-led and was delivered by forensic medical officers (FMOS). FMOs continue to play a vital role in delivering custody healthcare in Musgrave, and continue to work on call.
“Having custody nurse practitioners embedded as part of the custody team, has resulted in greater confidence in detaining people under the influence of drugs and alcohol and for minor injury not having to go to hospital. This means fewer police officers are being taken away from frontline duties and having custody nurse practitioners work as part of the team brings an additional level of reassurance and know-how to the environment.”
CNPs triage detainees in custody and can assess, treat and, when necessary, refer them on as appropriate.
Department of Health Permanent Secretary Richard Pengelly said: “This innovative pathfinder is a joint initiative between the health and justice sectors, made possible by transformation funding. The introduction of a highly skilled nurse-led service has already delivered in terms of improving the quality of the healthcare service and outcomes for patients in custody and reducing Emergency Department visits. This initiative shows what can happen when government works across boundaries to meet the needs of people in Northern Ireland.”
Siobhán McIntyre, Assistant Director of Nursing at the Public Health Agency (PHA), said: “Through the development of Custody Nurse Practitioners, nurses have stepped up to this challenge, combining the skills of managing acutely ill patients with both mental and physical health needs, as well ensuring access to therapeutic interventions to address distress, alongside the provision of support to assist in lifestyle changes.”
Bernie Owens, Belfast Trust Director of Unscheduled and Acute Care, said: “We are very pleased to be able to partner with the PSNI in the delivery of this new custody healthcare model at Musgrave Station. Our specially recruited, forensically trained nurses are able to provide excellent person-centred, compassionate care, evaluating a person’s health needs in a carefully designed suite meeting our infection control and governance standards. Our nurses’ skills are highly effective in de-escalating difficult situations and they are working collaboratively with police officers, custody officers and with forensic medical officers to provide a holistic approach. This is joined-up working in a new setting within the Northern Ireland context and it is proving to be very effective.”
A Department of Justice spokesperson said: “The Department of Justice welcomes the new custody healthcare model, a joint endeavour which will deliver improved outcomes through enhanced collaborative working across the health and justice sectors and which is, therefore, very much in the spirit of the Programme for Government.”
In 2017/18 91 per cent of detainees were examined by an FMO. Since CNPs started working independently, 12% of detainees have been referred by the CNP to an FMO. This has resulted in savings of £766,000, most of which will be reinvested in enhancing the provision of custody healthcare within PSNI.
Una Williamson continued: “Once the new service is in place in all PSNI’s nine custody suites, FMOs will be retained on an on-call basis as there are still a number of instances where a doctor is required. For example, the Road Traffic Order in Northern Ireland requires a doctor to decide if driving impairment is due to intoxication by drugs; this requires legislative change.
“The aspiration of a Health and Social Care led Custody Healthcare Service is to enhance the current FMO-only model by adding Custody Nurse Practitioners. The aim is ensure detainees have access to the same quality of care in custody as elsewhere and provide compassionate equality of care for all detainees, some of whom are marginalised by society due to vulnerabilities, such as homelessness, mental ill health, addiction, or by the nature of their offending.”
During the summer, PSNI, in partnership with the PHA will invite expressions of interest to ascertain which Heath and Social Care Trust Trust/s will deliver the regional custody healthcare service. It is planned to have three custody hubs in Musgrave and Antrim; Strand Road, Derry/Londonderry and in Lurgan.