In March 2011, Professor Stephen Shute’s workstream presented a paper to the Ministerial Board on Deaths in Custody. The paper, which contained three recommendations, provided a summary of the main mechanisms for collecting and sharing information about an individual’s health needs and risk of suicide/self-harm and an assessment of the effectiveness of these mechanisms.
These were accepted in principle, pending further meetings with the custody sectors to refine and develop them. In May 2011, the IAPDC met with officials from NOMS, ACPO, YJB, UK Border Agency and Department of Health and it was agreed that the IAPDC would formulate a simple statement for practitioners, reminding all criminal justice agencies of the need to share information to provide a continuity of care for a detained individual.
Information sharing statement
In July 2011, the information sharing statement reminding custodial staff of the need to share information on a detainee’s risk of suicide/self-harm was developed by the IAPDC. A meeting was held between Professor Shute and Lord Harris with Christopher Graham, the Information Commissioner, to discuss the statement which was believed would go some way to ensuring that the Data Protection Act was not seen as a barrier to sharing information. At the Ministerial Board in Deaths in Custody in October 2011, Professor Shute presented the statement and Board members endorsed it as a sensible way of ensuring information sharing. Furthermore, in March 2012, the IAPDC met with the General Medical Council who also thought the statement was a sensible initiative they were happy to support. In July 2012 the IAPDC wrote to service leaders to ask them to disseminate the statement and consider how best to do this in the context of their own organisations.
In August 2013, the University of Greenwich consortium carried out a preliminary evaluation of the impact of the information sharing statement following its dissemination. Those who had originally been sent the statement were contacted and a series of interviews conducted which explored how important information typically flowed in the organisation, how the information statement was disseminated, and whether they believed that the statement had had an impact on practice. The investigation found that there was great variation across the organisations in the methods of cascading the information and it was quite likely that ground level staff would not have seen the statement.
Lord Harris circulated the consortium’s report and recommendations to the Ministerial Board on Deaths in Custody in February 2014; he acknowledged a consensus that poor information sharing was consistently indicated in deaths in custody and that more effort would be needed to ensure the changes are implemented in a practical way. The IAPDC discussed the approach at their meeting in May, and agreed that instead of simply re-issuing the guidance, it would be helpful for the IAPDC to meet service leads to agree the best way of ensuring implementation in each organisation to support staff to change their behaviour and improve practice.
Person Escort Record (PER) forms
In August 2011, Professor Shute met with officials from His Majesty’s Inspectorate of Prisons (HMIP) and Her Majesty’s Inspectorate of Constabulary (HMIC), where they agreed to undertake an analysis of Person Escort Record (PER) forms, which are used to convey information on an individual as they move through the criminal justice system. In 2011, HMIP and HMIC inspected 181 PER forms from five forces to examine the extent to which information about the risk of self-harm obtained during detention in police custody was accurately recorded and likely to be useful in subsequent care planning as the detainee moved along the criminal justice system.
This was a small sample, as 1 million PERs are completed each year. Nevertheless, they found that forms were not fully completed in 33 out of the 181 cases. Concerns were also highlighted about inconsistent or vague information and a lack of concordance between risk information on the PER and that on police custody records.
Following the initial analysis of a sample of police PER forms, HMIP conducted further fieldwork in prisons and Young Offender Institutions (YOIs) to identify how the PERs originating from police custody were being used as the individual was taken into prison custody. In terms of initial findings, whilst prison staff used the PER as a means of flagging that there was a concern of self harm, detailed information about this risk was being conveyed to the prison in other ways.
In the five prisons and YOIs HMIP had inspected as part of this work, SystmOne was being used effectively to convey healthcare information relating to a prisoner. Furthermore, fieldwork also evidenced that prison staff were developing informal systems to convey information within the prison to make up for perceived shortfalls with the PER. The inspections also found that information held on the PER was not being used by staff when completing the Assessment Care in Custody Teamwork (ACCT) process. HMIP presented its findings in full to the Ministerial Board on Deaths in Custody in October 2012.
NOMS worked to identify potential solutions which delivered a digital PER across a number of service users, including the escort contractors. This included the use of existing data systems and the potential for these to be connected, though it is recognised that it would not be delivered in the short term.
Assessment Care in Custody Teamwork (ACCT)
ACCT is the key process used in prisons to identify and manage the risk of self-harm and suicide.
In 2013, the IAPDC asked the University of Greenwich to scope the effectiveness of ACCT in prisons and equivalent processes in other settings for managing risk of self-inflicted deaths. As part of this review the research team visited four prisons, including one female prison. The research team produced a paper on early findings, and conducted a review of the 15 most recent HMIP reports to ascertain the Inspectorate’s findings on ACCT.
The IAPDC considered this work alongside the outcome of an internal NOMS review on the use of ACCT with young people and PPO learning bulletins on this topic to determine the scope of the project in future.
Terms of Reference
The working group considering the issue of information flow through the Criminal Justice System (CJS) include:
- Identify how the different criminal justice agencies collect information on an individual’s mental and physical health needs and risk of suicide/self-harm and identify how this information is shared with other agencies as the individual moves through the CJS.
- Assess the effectiveness of these mechanisms and highlight points in the system where this information could be more effectively shared to ensure that continuity of care is maintained and unnecessary delay or risk is avoided.
- Build links with the National Programme Board and Advisory Group, which have been established to implement the recommendations of the Bradley Report in order to explore the implications of this for the work of the IAPDC. The recommendations of the Magee Review of Criminality Information will also be considered as part of this work.
- Present the IAPDC with a report summarising the key findings and recommendations for consideration.