CONTENTS

Glossary of terms and abbreviations

Who is this for and what does it do?

Over-arching ethos

Good Practice Case Studies

Local Operating Protocols

Examples Requiring a Police Response

Restraint and Restrictive Practices

Learning the Lessons

The Next Steps

Appendix One – The Law

Appendix Two – MH ERG Membership

Appendix Three –

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GLOSSARY OF TERMS AND ABBREVIATIONS

Chemical restraint – restraint involving the use of drugs under medical or nursing direction.

Manual restraint – any direct physical contact where the intervener’s intention is to prevent, restrict, or subdue movement of the body, or part of the body of another person.

Mechanical restraint – restraint techniques which rely upon the use of equipment, for example handcuffs, soft-cuffs, emergency restraint belts.

MCA – Mental Capacity Act 2005

MHA – Mental Health Act 1987

PACE – Police and Criminal Evidence Act 1984

Restrictive Practices – this is the generic term use within this document to mean any kind of restraint, manual handling, threatened or actual use of force or other therapeutic intervention that involves the threatened or actual use of force.

RIDDOR – the Reporting of Injuries, Diseases and Dangerous Occurrence Regulations 2013 –

Therapeutic intervention – used in this document describe practices which are a part of healthcare delivery for patients, distinguished from interventions which are for the purposes of preventing crime

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MEMORANDUM OF UNDERSTANDING – Police attendance and / or restraint in mental health, learning disability and place of safety settings.

Foreword The police service and the health service exist to deliver distinct public service functions which occasionally overlap and require joint working. It is vital to patient, staff and public safety that individual professionals and organisations understand how these functions interface with each other when responsibilities overlap in connection with restrictive practices.This document relates to the first of two phases of work – Phase one aims to provide clarity on

police attendance at mental health and learning disability in patient settings and health based Places of Safety.

Phase two will address restraint related actions outside those settings.

Both phases aim to improve the clarity and understanding with which police officers exercise their professional judgement in support of colleagues from healthcare providers when they are called upon to do so. The overall aim is to ensure the health and safety of patients, professionals and the public.

The Independent report of the Mental Health taskforce commissioned by the NHS describes the current state of mental health in patient care including:

Admissions to inpatient care have remained stable for the past three years for adults but

The severity of need and the number of people being detained under the Mental Health Act continues to increase, suggesting opportunities to intervene earlier are being missed.

The number of adult inpatient psychiatric beds reduced by 39 per

cent overall in the years between 1998 and 2012.

Bed occupancy has risen for the fourth consecutive year to 94 per cent.

Many acute wards are not always safe, therapeutic or conducive to recovery.

Pressure on beds has been exacerbated by a lack of early intervention and crisis care.

On occasions, mental health care involves the use of restrictive practices. Detention under the Mental Health Act 1983 removes the liberty of individuals and can lead to decisions about medical treatment being taken by others, without the consent of patients. Whilst all efforts are made to reduce restrictive practices, patients are occasionally subject to restraint in order to ensure their own and other peoples’ safety. The risks associated with restraint are significant and both the police service and healthcare providers have experienced incidents where patients under restraint have died. Where agencies find themselves working in close partnership amidst a need for rapid decisions, the potential for unclear communication, conflict between organisations’ guidelines and different restraint practices have the potential to increase the difficulty in ensuring a safe and effective outcome.This document aims to improve patient and staff safety by ensuring the right organisation provides the right response to patient safety incidents, based on assessment of risk and other factors. The document outlines an approach to the assessment of incidents involving risk and instils the need for clear operational leadership during joint incidents. The overall aim is to ensure clear communication and understanding that

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services should work closely and effectively. The evidence is clear, all restraint is associated with increased levels of risk and no period of time spent under restraint is inherently safe – this includes prone restraint.

This memorandum of understanding, instigated by the National Police Chiefs Council (NPCC) Business Area for Mental Health has involved the Department of Health, Home Office and NHS England, and was co-ordinated by the College of Policing, who formed the Mental Health / Restraint Expert Reference Group (MHRERG – See appendix two) The MoU brings together guidance from policing and health, reflective of lessons learned from previous cases as well as near misses. It aims to synthesise positive practice and provide guidance for every mental health provider and police service in England and Wales.This guidance will be part of the mental health Crisis Care Concordat local action plans in both England and Wales.The MHRERG will periodically review the impact of this guidance.

Chief Constable Alex MARSHALL – CEO, College of PolicingWHO IS THIS FOR AND WHAT DOES IT DO?

This document applies to –

All operational police officers who may respond to requests for support from in-patient mental health and learning disability services and health based Places of Safety

All healthcare staff who work in these settings

The document covers –

What the NHS are committed to doing

What the police are committed to doing

How to manage the uncertainties which may emerge.

It applies to all patients regardless of whether they are detained under the Mental Health Act 1983.

Commander Christine JONES –NPCC Lead on Mental Health

Named signatory from Department of Health and / or NHS England?

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GOOD PRACTICE CASE STUDIES –

These case studies highlight good practice when the police were called upon and communication was clear.

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CASE STUDY ONE:

An adult female patient was detained under the MHA in a psychiatric intensive care unit. The patient damaged a window on the ward and secured several pieces of glass as weapons, barricading herself in a room. Nurses and other staff secured the immediate area, moving other patients away and began to try to de-escalate the incident. The patient remained inside, threatening to harm staff who entered the room and the decision was taken to call the police.

The request here was to ask the police to assist in preventing crime and protecting life.

Staff continued to negotiate without success and officers arrived. The police sergeant in charge discussed the background of the patient and the incident with the nurse in charge. The lead nurse asked police officers to take over negotiations to see if the approach of other professionals could de-escalate the incident and requested that the police consider reasonable force to enter the room, remove the weapons and move the patient a short-distance down the corridor should negotiate fail. Nurses offered to then take back control of the situation and seclude the patient.

The legislative power to consider here is to use s3 of the Criminal Law Act to prevent crime.

Officers tried and failed to de-escalate the situation. They then entered the room using protective equipment, restrained the patient and removed the weapons. When this had been achieved they moved her to the adjacent room where nurses were ready to take over. Having done so, the officers disengaged and resumed their other duties, leaving the sergeant to discuss the post-incident issues.

Nursing staff restrained the patient for medication under the MHA and left her in a seclusion room under supervision.

Ten minutes later, the nurse undertaking observations identified that the patient has removed another piece of glass from her vagina and is now using it to self-harm, indicating she will attack staff who enter. The senior nurse again contacted the police.

The legislative power to consider here is to use s3 of the Criminal Law Act to prevent crime and Common Law.

Because the patient was actively self-harming, the police made only limited efforts to negotiate before re-entering the room and using reasonable force to remove the weapon. Nursing staff then again took over the situation.

The legislative frameworks to consider are the MCA and Common Law.

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CASE STUDY TWO:

An adult male patient without any previously identified risk of assaultative behaviour declined to receive medication to treat his mental health conditions whilst detained under s3 of the Mental Health Act. A senior nurse convened four staff to administer medication without consent under Part IV of the MHA. During the course of attempting to restrain the patient, one nurse is assaulted by the patient and his jaw is broken. He instantly disengaged from the situation and is in considerable pain. A second member of staff disengaged for her own safety and also attended to her colleague’s immediate first aid. It is decided to ring 999 for police and ambulance to attend the ward. The request here is in connection with a serious assault and necessary for the prevention of further injury to staff or to the patient.

Remaining staff also disengaged from the restraint because they were unable to control the patient who has assaulted the other two, thankfully less seriously by hitting them to the upper arm in an effort to push them away. They suffered pain and discomfort. Staff attempted to de-escalate the situation whilst calling 999 and discussing what to do next. The police arrived with paramedics and the police sergeant in charge asks what they are being asked to do whilst paramedics attended to the seriously injured nurse. Nursing staff asked officers to assist them in removing the patient to a seclusion room because three of them have been assaulted and cannot be confident of avoiding further assault without support. The nurses state that the patient will need to receive medication before being left in seclusion and under nursing observations.

The legislative power to consider here is to use s3 of the Criminal Law Act to prevent crime and to assist nursing staff under the MHA. << Legal check.

Police officers spent a short amount of time talking to the patient who seemed to calm somewhat and along with two nursing staff who remain involved moved the patient using low level manual restraint to control his arms whilst moving him to the end of the ward where the seclusion room is situated. Once inside, nurses talked to the patient about receiving medication and he again became aggressive insisting he doesn’t want an injection. He started to attempt to leave the room pushing officers away using his arms. Nurses had insufficient resource available to restrain him on their own and it was agreed that police officers would assist.

The legislative power to consider here is still s3 of the Criminal Law Act to prevent crime against nursing staff and the MHA itself. << Legal check.

COULD POLICE INVOLVEMENT BE AVOIDED IF :nursing staff knew the nature and degree of resistance that would be likely from patient and where the patient would require medication at 8pm when only four nurses were on duty. What considerations should be given before the end of normal business hours to increase the likelihood of such a situation being managed solely by nursing staff?

LOCAL OPERATING PROTOCOLS –

All health providers and police services in England and Wales should agree local protocols across relevant policing and health areas, to maximise clear communication and cooperation and achieve a consistency of response to mental health and learning disability inpatient settings and health based places of safety. These local protocols should form part of the local crisis care concordat.

As a minimum these protocols should cover the following issues, and include –

Joint protocol commitments –

To prevent and respond to violent or disturbed behaviour, including –

Staffing in both health and policing to be able to discharge their respective legal responsibilities.

Effective information exchange between police & health in order to aid assessment of risks that may present to staff, in line with section 115 of the Crime and Disorder Act 1998 (Disclosure of Information).

Escalation procedures in each agency to problem solve, both at the operational and strategic levels.

Provision for the joint review of individual cases, where necessary – including any informal debrief immediately required after an incident or a more formal serious incident (SI) or near miss review, where required.

Oversight of the effectiveness of local arrangements and any need for local (joint) training from management information.

Data monitoring and reporting processes

Health provider commitments –

Local risk assessment for the purposes of staffing requirements and contingency planning.

All clinical interventions (e.g. taking of fluid samples, injections, etc.) with or without consent and in accordance with the law e.g. MHA status.

Take steps that are reasonably practicable to safeguard other patients and other staff during incidents to which this MoU relates.

Those restrictive interventions allied to psychiatric care; for example – The transfer of patients to a

seclusion area. Transfer of patients; within or

between mental health units or Accident & Emergency.

Administration of treatment without consent (Part IV MHA / Mental Capacity Act).

Ensure we refer to Apdx 3 – pre-meet, pre-brief.

Maintaining physical observations in the event of any restraint.

Retaking control of any restraint as soon as it is safe to do so.

Initiating and implementing a joint post incident review, where necessary.

Ensuring attending police are fully aware of any physical health issues that may affect safety prior, during or post incident

Allocating a lead member of staff to co-ordinate the incident and instruct and inform attending police.

These examples are subject to the existence of any exceptional factors – see p 9 to 10 ‘ethos’.

Police commitments –

Investigation of any allegations of criminal conduct. (NHS Protect)

Response to serious crime, including incidents involving weapons, barricades or hostages – see examples, below.

Through effective response, prevention of immediate risks to life or serious damage to property.

Any action under the direction of court under Part III of MHA – for example, detention or conveyance connected to s55 MHA.

Using the National Decision-Making Model (NDM) to identify the most appropriate actions and tactics (see appendix 4 for NDM and p9)

EXAMPLES REQUIRING A POLICE RESPONSE –

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An immediate risk to life and limbA patient has returned from authorised s17 leave and is in possession of a large knife. Where they have produced this weapon and threatened harm to staff an immediate police response will be necessary. Where they have left it unattended in their room and staff can safely take possession of it, police immediate attendance would not be proportionate.

Immediate risk of serious harmA patient is exhibiting disturbed behaviour on a ward after returning from leave believed to be under the influence of drugs. Nursing staff have attempted to seclude the patient for their own and others’ safety following one nurse being punched causing grievous injury which requires assessment in an Emergency Department. Nurses are now asking for police support to complete the seclusion because of the further risk of serious harm to staff. A police response would be appropriate.

Serious damage to propertyA patient in an inpatient unit has caused damage to ward infrastructure including a kitchen area where they have broken chairs, tables, windows and appliances, the floor is covered in debris and the patient continues to cause damage and throw the debris around the room. A police response would be appropriate.

Offensive weaponsA patient has told staff upon return from leave that they have a knife on them for their own protection because they believe that nursing staff will harm them by giving them more drugs. It is known that the patient has a pervious history of possessing offensive weapons or sharply pointed implements. A police response would be appropriate.

Hostages

A patient has closed the door to their own room whilst a nurse is inside and is shouting, threatening to harm the nurse if anyone enters the room. The patient is asking to be allowed out of the unit as a condition of releasing the nurse and state they will harm them unless this is agreed to. There is no indication one way or the other as to whether the patient has a weapon and the noise from within the room suggests that furniture has been piled against the door to block entry.

Thinking Through the Examples –

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THE OVER-ARCHING ETHOS

Each situation should be properly judged on its individual merits –

Police officers should be called to undertake restrictive practices, connected to purely clinical interventions (e.g. taking of fluid samples, injections, etc.) only where exceptional factors apply.

These could include, but are not restricted to –

An effort by healthcare staff to undertake a restrictive intervention without police support has led to injury to staff which compromises their ability to continue safely; OR

No other support from healthcare colleagues is available or appropriate in a sufficiently timely manner to ensure safety of all those affected.

The police service should ensure an appropriate response to allegations of crime and to requests for immediate support in connection with risks of serious injury or damage, where NHS internal mechanisms have been unsuccessful and safety is then compromised.

Any Dispute about pre-incident issues are matter for review

Build up to 999:

Good local relationships between providers and the police should be developed to help prevent violent situations arising through early intervention techniques and regular inter-agency dialogue.

Where a restrictive intervention is required, NHS organisations should have arrangements to convene sufficient appropriate staff to mitigate foreseeable risks – this can include cross-ward support arrangements.

Where a therapeutic intervention has been attempted and staff have been injured and are unable to gather wider NHS support, police officers may be requested to assist because of the ongoing risk to staff safety and their diminished ability to ensure the safety of that intervention. When so deployed police officers must work within an appropriate legal framework (see Appendix 1)For example, the police should not be expected to assist health staff in responding to a patient who is presenting behavioural or clinical management issues (including their transfer from one service to another), unless those exceptional or aggravating factors apply.

There should always be plans, led by the health provider, to manage de-escalation, summoning additional staff, transporting or escorting of patients and health staff use of restraint; rapid tranquillisation must be considered before police are requested.

A health focused incident response plan should be in place to enable staff to safely assess and confidently manage foreseeable risk situations, making a request for the police an exceptional circumstance. (See Appendix 5)

Any decision to call the police should be properly evaluated and consistently applied, in line with local protocol.

Police contact handling / response:

No assumption should be made by police officers that any incident involving any patient will always be a matter for the NHS alone; or that offences committed by a patient cannot or should not be investigated or prosecuted.

Where the senior police officer at the incident has concerns about the appropriateness of police involvement, they should exercise their professional judgement on the legal powers available to them (see Appendix 1) in that context and refer the matter to the duty officer.

Where the senior nurse has concerns about the appropriateness of the police response, they should escalate that to the duty police inspector and to their own managers.

Post-incident:

Each organisation should ensure accessible mechanisms to allow for a subsequent joint-review.

All police and health services should detailed records of the incident, report according to local policies and commit to joint review and to shared, ongoing organisational learning.

Collate data for reporting and analytical purposes.

What constitutes a reasonable ‘mitigation of foreseeable risk’ will vary across healthcare providers and individual hospitals because of the variety of patient needs amongst and the location of infrastructure in which a particular patient’s care is delivered.

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RESTRAINT AND RESTRICTIVE PRACTICES –The importance of de-escalation and other verbal skills in managing violence and aggression by ALL agencies cannot be overstated. Appropriate preventative strategies are known to be effective in preventing / lessening incidents of violence and aggression and the corresponding need to consider the use of any force.

All staff using restraint to deal with violence and aggression from people suffering from mental health issues or physical illness, should be aware of potential additional problems, (e.g., medication, obesity, co-morbidity of drug and alcohol problems; Acute Behavioural Disorder ABD). These factors can raise the risks of restraint. The long lasting impact and distress caused to patients, staff and relatives can be substantial. For these reasons, wherever possible, every effort must be made to utilise methods of dealing with violence and aggression that does not involve the use of restraint. It must be remembered that any period of restraint can be dangerous. Prolonged periods of restraint can be especially dangerous (particularly where this occurs on the ground) and features significantly in restraint-related deaths. It is, therefore, important to reduce the time a person is restrained to a minimum. No restraint position can ever be

totally safe or free of risk. The expression “safer restraint” is preferable to “safe restraint”.

All take-down techniques carry additional risks.

Prone and supine restraint positions both carry (different) risks. It is wrong to consider one safer without fully understanding the practical application.

Take-down techniques are often overused or used when they are not entirely necessary. When used, the person should be brought to the standing position as soon as possible.

Care must be taken to avoid anything that impacts on the patient’s airway, breathing or circulation. The mouth and/or nose must never be covered and pressure should not be applied to the neck region, rib cage and/or abdomen.

The person must be effectively monitored in accordance with the NHS patient safety alert of December 20141.

However any person has the common law right to use reasonable force to protect themselves and others from life threatening situations. Furthermore appropriate training of staff will increase an organisations capacity and capability to deal with potentially violent situations. Effective training will enable staff to be more self-sufficient and will result in fewer requests for additional health staff and police attendance. The Department of Health is leading work to develop national standards for the prevention and management of violence and aggression.

Medical oversight –

It is important to consider all aspects of medical oversight during restraint. This should include a discussion about specific roles and responsibilities. This must include an understanding of –

What should the healthcare staff do during and after restraint?

What is the minimum requirement for observations during the restraint and who should do this?

How quickly can/do medical staff get to the scene of a restraint and what should happen before their arrival and upon their arrival?

In certain circumstances, restraint should be treated the same way as any other medical intervention. These circumstances need clarifying.

1 https://www.england.nhs.uk/wp-content/uploads/2015/12/psa-vital-signs-restrictive-interventions-031115.pdf

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After any form of manual restraint is used on a patient, health staff should monitor the patient’s physical and psychological health for as long as clinically necessary.2

Insert the PSA from NHS England << I will do this for next iteration: inserting PDFs into Word documents is beyond me!

Gary / Guy to send health figures for last year or last three years? >> In the years 2012-14 there have been 39 deaths in police custody, 25 of which were connected to vulnerable people with mental health problems and X (7+?+?) involved restraint. << Include NHS or health figures when provided.

Both police and health staff may have access to manual and mechanical restraint options. For health staff mechanical restraint is defined in NICE NG10 as “a method of physical intervention involving the use of authorised equipment for example

handcuffs or restraining belts, applied in a skilled manner by designated healthcare professionals. Its purpose is to safely immobilise or restrict movement of part(s) of the body of the service user.”

Police officers have a range of manual and mechanical restraint options available to them and receive appropriate training in their use. These include handcuffs, body and leg restraints, plus use of incapacitant sprays, Taser and other lethal and less lethal weaponry. All if these options will be considered by police officers called to deal with violent patients and will be deployed in line with the National Decision model.

It is vital that any joint agency use of restraint is supported by clear and highly effective communication between the staff involved to ensure the safety of patients and staff.

2 NICE NG10 para 1.4.33

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LEARNING THE LESSONS –

Procedures should be established for joint organisation learning where incidents in mental health or learning disability inpatient units or mental health place of safety locations require the involvement of the police or other state agencies. Where appropriate, all the relevant agencies should be involved in the organisational learning review process to maximise informed learning to prevent recurrence.

Three key levels are as follows and should in all cases be led by the mental health service provider:

Local (level 1)

In the event of a near miss, no injury incident, non-RIDDOR reportable injury –

A local review, led by the mental health service provider with appropriate police or other agency inclusion. This organisational learning should at the very minimum be shared locally and with all the agencies involved in the incident. This should inform local procedures, arrangements and processes. Opportunities to share learning via local health professional and police professional groups should be encouraged as open and transparent learning.

Serious Incident Review (level 2)

In the event of a serious incident as defined by the NHS Serious Incident Framework, notifications that fall within RIDDOR or repeated level 1 failures –

The mental health service provider should review in accordance with the NHS Serious Incident Framework –

http://www.england.nhs.uk/ourwork/patientsafety/serious-incident/

This review is to be led by the service provider with appropriate police or other agency inclusion. Notification should be in accordance with RIDDOR and the NHS Serious Incident Framework.

Organisational learning will be captured and disseminated as part of the Serious Incident Review Process;

Statutory Enforcement (level 3)

In the event of a fatality, incident requiring investigation e.g. CQC instigated, HSE investigation criteria, or a complaint made to an enforcing authority –

This will generally take the form of an enforcement investigation by the HSE and/or CQC. The police will lead if the investigation is one of murder, manslaughter or corporate manslaughter. The IPCC may also investigate if there is a death in police contact. Formal statutory level 3 investigations will generate national learning outcomes via statutory body guidance, HM Coroners inquests (Reg 28 notices), changes in local or national guidance and reports such as the IPCC learning reports.

https://www.ipcc.gov.uk/reports/learning-the-lessons/learning-lessons

The relevant lead agency such as the NHS and Police will often also issue national learning, guidance and changes in practice following serious incident investigations at this level. These investigations will also need to adhere to the following which define investigation criteria, responsibilities and information sharing agreements:

Memorandum of Understanding between CQC, the HSE and Local Authorities in England –

http://www.hse.gov.uk/aboutus/howwework/framework/mou/mou-cqc-hse-la.pdf

HSE and IPCC protocol for liaison with the Health and Safety Executive (HSE) in investigations (November 2007)

Work Related Death Protocol - http://www.hse.gov.uk/pubns/wrdp1.pdfHSE and Local Authority Incident Selection Criteria 22-13 –

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http://www.hse.gov.uk/lau/lacs/22-13.htm

Work-related deaths: liaison with police, prosecuting authorities, local authorities, and other interested authorities including consideration of individual and corporate manslaughter / homicide –

http://www.hse.gov.uk/foi/internalops/ocs/100-199/165_10.htm All mental health services and the police, should maximise the learning opportunities and ensure the lessons to improve understanding, guidance, practices, processes are exploited. Health commissioners have a key role to play in ensuring this translates into the provision of effective, safe and progressive services.

THE NEXT STEPS –

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Next steps – This Memorandum of Understanding

will be included and referenced in future National Mental Health Crisis Care Concordat action plans and publications

All Local Mental Health Crisis Care action plans to include development of protocol to embed this Memorandum of Understanding in to local working practices.

MHRERG to continue to monitor and update this Memorandum of Understanding on an annual basis, to reflect improvements in staff training, lessons learnt and legislative changes

The MHRERG will commence Phase 2 of the restraint work exploring how the use of restraint by police is reduced in incidents involving mental health conditions in non-mental health settings and public places.

Appendix One – THE LAW

Over-arching frameworks –All Health and Police Services are governed by the over-arching requirements of human rights and Health & Safety Law. Whatever local protocols and practice look like, they must be capable of defence against those over-arching requirements. In particular, the following aspects of –

Human Rights Act 1998

Article 2 – the right to life. Article 3 – the right not to suffer inhumane and degrading treatment. Article 5 – the right to liberty and security.Health & Safety at Work Act 1974

Section 2 - employers should ensure, so far as is reasonably practicable, the health, safety and welfare at work of all employees.

Section 3 – employers should conduct their undertakings in such a way as to ensure, so far as is reasonably practicable, that persons not in their employment who may be affected are not thereby exposed to risks to their health and safety.

Section 7 – employees should take reasonable care of their own health and safety and that of others who may be affected by their acts or omissions at work; and cooperate by following any requirement imposed on them by their employer.

Management of Health and Safety at Work Regulations 1999

Regulation 3 – every employer shall make a suitable and sufficient assessment of the risks to the health and safety of his employees to which they are exposed whilst they are at work; and the risks to the health and safety of persons not in their employment arising out of or in connection with the conduct of the undertaking. (Need to be foreseeable risks, and you are not expected to eliminate all risks, but protect people as far as is reasonably practicable).

Regulation 5 – employers need to introduce preventative and protective measures to control the risks identified by the risk assessment.

Police powers – There are very few police powers which are, in fact, exclusively reserved to the office of constable. Many legal authorities perhaps considered to be police powers are, in fact, those for all citizens, including healthcare professionals.

The Police and Criminal Evidence Act 1984 –

Section 24 PACE – this provision is the power for constables to arrest individuals for an offence.

Section 117 PACE – where any provision of PACE confers a power upon a constable and does not provide that the power may only be exercised with the consent of some person, other than a police officer, the officer may use reasonable force, if necessary, in the exercise of the power.

Code G (2012) of the Codes of Practice to PACE –

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Where an offences is alleged or has occurred, it does not automatically follow that police officers may arrest that person - it remains subject to the ‘necessity test’.Grounds of necessity include – To ascertain the person’s name or address. To prevent the person –

causing physical injury to himself or any other person suffering physical injury causing loss of or damage to property committing an offence against public decency causing an unlawful obstruction of the highway.

To protect a child or other vulnerable person from the person in question To allow the prompt and effective investigation of the offence or of the conduct of

the person in question; To prevent any prosecution for the offence being hindered by the disappearance

of the person in question.

Detention in police custody -

Many of those grounds of necessity would apply to situations under consideration in this MoU and it is relevant to consider what happens after arrest: constables must remove any arrest person to police custody and bring them before the custody officer (also usually known as the custody sergeant). The custody officer must then assess, under s37 PACE, whether there is sufficient evidence to charge the person with the offence for which they have been arrested.Where such evidence exists, they must charge the person; where it does not they may only detain the person in custody where this is necessary to secure and preserve evidence or obtain evidence by questioning. They must also, at all times have regard to the health of the person under arrest and ensure their wellbeing – anyone whose health is at risk in custody must be examined and potentially transferred to hospital.Once the grounds for detention in police custody cease to apply, s34 of PACE directs the custody officer to bring that person’s detention to an end. This is an assessment based upon the evidence for a criminal prosecution and is not based on any other consideration, including difficulties in securing transfers of MHA patients to more restrictive settings. In addressing the question of whether any patient has allegedly offended, these considerations around arrest and detention should be borne in mind.

Mental Health Act 1983 –Where a patient is detained in hospital under the main provisions of either Part II or Part III MHA, they are liable to treatment decisions to be taken without their consent, under Part IV of the Act. This covers various circumstances in which medication may be administered as part of an overall approach to their care and covers emergency situations.I’m going to type nothing more on this section until the legal advice comes back! << Needs finalising!Common Legal Provisions –All citizens may rely upon the following statutory and common law provisions to intervene in a situation to keep themselves or others safe from harm. It will be a matter

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of risk assessment, competence and degree as to whether any intervention should be undertaken by health or policing professionals under these frameworks –

Common Law –

The common law is based on the precedents which have been accepted by the courts and is not set against the background of Acts of Parliament. There are therefore no ‘sections’ to which to refer, as mentioned above for PACE.

Doctrine of Necessity – Baroness HALE said in the Court of Appeal in 2003 that “there is a general power (under the common law doctrine of necessity) to take such steps as a reasonably necessary and proportionate to protect others from the immediate risk of significant harm. This applies whether or not the patient lacks capacity to make decisions for himself.”

Breach of the Peace – this fourteenth century common law provision has now been affected by modern human rights legislation and has limitations that need to be understood. A Breach of the Peace is any situation in which harm is caused to a person or to their property in their presence. In 2014, the Court of Appeal ruled that arresting someone to prevent a Breach of the Peace was only lawful where officers intended to take that person before a Magistrate. This ruling is subject to appeal to the Supreme Court and the MH ERG will keep this under review during 2016/7.

Section 3 of the Criminal Law Act 1967 –

A person may use such force as is reasonable in the circumstances in the prevention of crime, or in effecting or assisting in the lawful arrest of offenders or suspected offenders or of persons unlawfully at large.This is the law of self-defence and the defence of others and may be relied upon by anyone.

Mental Capacity Act 2005 –

Where a person thought to be suffering from an impairment or disturbance of the mind of brain lacks capacity concerning a particular decision another person may do the least restrictive thing in their best interests. Section 5 of the MCA will provide a defence to that individual from legal liabilities that would otherwise occur as long as they have taken steps in accordance with the Act to assess capacity and acted in accordance with the general principles of the MCA.Where an action may extends to restraint of the person who lacks capacity, by the threatened or actual use of force, this may only be justified under section 6 MCA where the intended restraint is proportionate both to the risk of harm and to the likelihood of that harm. If restraint extends to such a degree that it amounts to an urgent deprivation of liberty, it may only occur subject to the criteria in section 4B MCA which requires that action to be a life-sustaining intervention or a vital act to prevent a serious deterioration in someone’s condition.

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Appendix Two – MHRERG MEMBERSHIP

Lord CARLILE QC (Chair)

Then group members in alphabetical order by surname

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Appendix Three – POLICE ATTENDANCE PROTOCOLOnce Police arrive at the mental health, learning disability and place of safety settings.

In situations where police are called to attend premises to regain control of a patient who is suffering from mental ill health, similar procedures as outlined below should be included in local protocols and agreements between partners.Step 1 – Decide RVP At the time Health/Care staff request the police to attend, a suitable Rendezvous Point (RVP) should be agreed. This is where the most senior police officer present can meet with the most senior member of health staff before police deployment onto the ward takes place. Depending on the circumstances and urgency of the situation, will dictate as to whether such an RVP is suitable.

Step 2 – Incident explainedPolice and Health staff meet at the RVP. Health staff will explain the incident, which should include any specific risks associated with the patient (e.g. whether the patient has already been restrained by NHS staff; whether tranquilisation has been administered and the effect this has had; highlighting any dangers and relevant health related issues). An assessment of available/sufficiently trained staff should also be made. Step 3 – Police/Health roles establishedIt is important to establish what the police are being asked to do. If further deployment is necessary both Health care/Police leads will work together to decide how best to resolve the incident. Police will consider the use of specialist officers/public order trained/hostage negotiator etc where relevant. Throughout the incident Health staff will remain responsible for the patients’ health and safety. This will require active monitoring of the patients vital signs. Health staff MUST alert police officers regarding any concerns as to the patient’s welfare throughout any period of restraint. Emergency resuscitation/defibrillator equipment with NHS trained staff should be immediately available at all times. Step 4 – Police handoverPolice will regain control of the ward/patient/situation using appropriate tactics. If police restraint is used, police will hand-over the patient to NHS staff as soon as control is regained. There should be sufficiently trained NHS staff to enable this to happen (unless exceptional circumstances, e.g.; health staff injured/unavailable).

Step 5 – Determine need for Criminal Investigation If a criminal act is alleged or the police determine that a criminal offence has been committed, a suitable police investigation should be instigated. If a patient is suspected to be responsible for a crime, it will be an exceptional set of circumstances where police will consider arresting and removing the patient from the health setting. The Police and Criminal Evidence Act 1984, Code G needs to be carefully considered. This does not mean a crime will not be investigated. The crime will be recorded by police and a statement obtained from relevant witnesses. A short statement/CPS approved proforma will also be obtained from a suitably qualified health practitioner in relation to the patient’s mental capacity at the time of the offence.

It’s expected that in the majority of cases, where a patient has committed a criminal offence, Police Officers will not arrest the patient. This may have implications for health staff and management in relation to how that patient’s treatment will continue. Issues around the ongoing safe management of the patient need to be carefully considered. If movement of the patient to an alternative hospital/ward is necessary, it is expected that health/care staff will manage this transfer, unless exceptional circumstances apply.

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Appendix Four – THE NATIONAL DECISION MODEL

To be inserted for final draft

Appendix Five – Effective Practice Partnership MoU

Partnership Protocol

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Contents

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Document Version Control

Document Type and Title:

Partner Agency Operational Protocol

Trust In-patient ServicesEmergency Police Response & Deployment and Post-incident Reporting of Assaults and/or Criminal Activity to Police Services

Authorised Document Folder:

Security Management Policy

New or Replacing: New

Document Reference:

Version No. 1

Implementation Date: 27th November 2014

Equality Impact Assessment Completed

Yes

Author: Giles PerrySecurity Management Specialist (SSSFT)

Approving body: Quality Governance Committee

Approval Date: 9 October 2014

Ratifying body: Trust Board

Ratified Date: 27th November 2014

Committee, Group or Individual Monitoring the Document:

Quality Governance CommitteeHealth & Safety Committee

Review Date: 27th November 2015

Page No.1.0 Introduction ANNEX 1 Procedures for Trust Staff to Call for Emergency Police Intervention ANNEX 2 Procedures for Post Incident Reporting to the Police ANNEX 3 Procedures for post incident investigation to be undertaken by the Police ANNEX 4 Victim Consent Form for Disclosure of Information ANNEX 5 Example of Witness Statement (MG11) to be given to the Police

1.1 Key Aims of the Protocol

3456789

2.0 Definitions 10

3.0 Rationale for Police Emergency/Immediate Response and/or Deployment of Officers 3.1 Type of Incident Justifying an Emergency Response and Police Officer Deployment 3.2 Procedures for Trust Staff to call Police for a priority/emergency response 3.3 Procedures for Trust staff and attending Police Officers on their deployment at scene 3.4 Powers and Duty of Care of Trust staff and Police Officers 3.5 Physical Interventions and/or Use of Equipment by Deployed Police Officers 3.6 Post Incident Review Procedures

10101111121213

4.0 Post Incident Reports to Police Services 4.1 Rationale for Post Incident Reporting to the Police 4.2 Process for Post Incident Reporting to the Police 4.3 Police Investigation Process 4.4 Police Interviews of In-patients Suspected of Committing a Criminal Offence 4.5 Monitoring Investigation Progress and Outcomes

131314151717

5.0 Partner Agency Signatories 18

1.0 Introduction

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The information contained within this Partner Agency Operational Protocol (“The Protocol”) will highlight processes and procedures to be adopted by South Staffordshire & Shropshire Healthcare NHS Foundation Trust (“The Trust”), North Staffordshire Combined Health Care and appropriate Partner Agencies in relation to the following:

Emergency Police Services response and deployment to Trust In-patient Units Trust support to assist Police where Officers have been deployed to an In-patient Unit as an

emergency response Reporting incidents of assault against the person and/or criminal activity occurring within

Trust In-patient Units to Police Services Supporting victims of assault and/or criminal activity where such an incident(s) has been

reported to Police Services Police Services post incident investigations into matters of assault against the person and/or

criminal activity Trust support to assist the Police with their investigation processes

To assist Trust staff and Partner Agencies in the application of the guidance and direction contained within the Protocol a series of Flow Charts and other supporting information are highlighted at the front end of the document – as follows

ANNEX 1 (Page 4)Procedures for Trust Staff to Call for Emergency Police Intervention and/or Deployment to Scene

ANNEX 2 (Page 5)Procedures for Post Incident Reporting to the Police (Incidents of Assault against the Person and/or Criminal Activity Instigated by In-patients)

ANNEX 3 (Page 6)Procedures for post incident investigation to be undertaken by the Police

Annex 4 (Page 7) Victim Consent Form for Disclosure of Information

Annex 5 (Page 8) Example of Witness Statement (MG11) to be given to the Police

Further information within the Protocol will detail strategic and statutory direction to support the rationale for the operational guidelines contained with Annexes 1, 2, 3, 4 & 5

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ANNEX 1 – Procedures for Trust Staff to call for emergency Police intervention and/or deployment to scene

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Trust Staff unable to safely manage incident and/or agreed response is required as identified in shared Risk Management Plan

Weapons involvedHostage taking

Serious harm causedImminent risk of serious harm being caused

Emergency Police Response RequiredCall 999

Information to be given to PoliceName and status of caller

Site & Ward/Service Area where incident is occurringName and status of instigator

Circumstances and/or type of incident (always advise if a weapon is involved – including the type of weapon)

Is the incident in progress/occurring now?Is there an imminent risk of incident occurring?

Name of Trust point of contact on their arrival at scene

Procedures on Police Officer Deployment at SceneOfficer in Charge to meet with designated member of Trust Staff at scene

Information shared in relation to nature of incident and status of instigatorAgreement to be reached on forward planning decisions to manage incident

(including duty of care/responsibilities & exit strategies/ contingencies)

Incident management initiated

Post Incident Review ProceduresImmediate review at the conclusion of the incident

Formal post incident partner agency case review within 7 days

ANNEX 2 – Procedures for post Incident reporting to the Police (incidents of assault against the person and/or criminal activity) instigated by in-patient

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Incident has occurred & decision taken to report to the PoliceTelephone call to be made to the Police by victim/injured party or the

Senior Clinician/Healthcare Professional on their BehalfPolice Contact Details by Service Area

St. Georges Hospital & George Bryan Centre West Wing & East Wing & Harplands HospitalStaffordshire Police

Tel: 101 The Redwoods Centre & Elms House

West Mercia PoliceTel: 101

Park House - BirminghamWest Midlands Police

Tel: 101

Information to be given to PoliceName and designation of person reporting the incident

Incident type – e.g. physical assault perpetrated against a member of staff by a patientDay, date, time & location of incident

Details of the instigator of the incidentDetails of the victim/injured party

Details of any witnesses to the incident

Information to be obtained from the Police Control Room from the member of staff making the report

Incident Log Reference and/or Crime Reference Number

Further Procedures to be undertaken by Trust StaffSecurity Management Specialist (or Nominated Deputy) to be advised that incident has

been reported to the PoliceSecurity Management Specialist (or Nominated Deputy) to be advised of Log

Reference/Crime Reference NumberTrust Incident Report to be updated (where possible) to include the above informationSecurity Management Specialist (or nominated deputy) to contact Officer in Charge to

review & agree investigation process

ANNEX 3 – Procedures for post incident investigation to be undertaken by the Police

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Incident has been reportedPolice to appoint Officer in Charge

Initial role of Police Officer in Charge OIC to make contact with Trust’s Security Management Specialist (or nominated deputy)

to discuss and agree terms of reference for investigation process

Procedures for gathering evidence & witness statementsOIC to liaise with Security Management Specialist (or nominated deputy) to

arrange for witness statements to be given by the followingResponsible Clinician Victim / Injured Party

Witnesses to the incidentOther appropriate Senior Clinicians

Police interview of patient who is suspected of committing a criminal offenceSignificant Decision Capacity Assessment to be undertaken by appropriate clinician to

determine fitness to be interviewed OIC to liaise with RC / Clinical Team to make appropriate arrangements for interview

All interviews to be undertaken in accordance with the Police and Criminal Evidence Act (PACE) 1984

Consent to Monitor Investigation Progress & OutcomesSecurity Management Specialist to provide OIC with Victim Consent Form for

Disclosure of Information

Annex 4: Victim Consent Form for Disclosure of Information

Victim Consent Form for Disclosure of Information

Alleged Offender details (if known):

Date and time of Incident:

Location:

Police log and/or Crime Reference no.:

Officer details if known:

I, [insert name and date of birth of victim] am the victim of the above incident. I give my consent for [insert name of Police service/CPS office] to provide information relating to the above incident directly to [insert name of Security Management Specialist and Trust details]

I also consent for the Police and/or CPS to provide updates on the progress of the case to [Name of Security Management Specialist] if they are unable to contact me directly.

I have been made aware of the duties of the Police/CPS to provide information and I understand that by agreeing to this arrangement the Police/CPS will have fulfilled their duties to notify me of developments.

Signed: Date:

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I, [insert name of Security Management Specialist] agree to receive information on behalf of the above named victim and accept responsibility for passing this information on promptly.

Signed: Date:

Date received and logged on police record:

Officer signature:

Annex 5 Example of Witness Statement (MG11) to be given to the Police

27

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1.1 Key Aims of the Protocol

The key objectives of the Protocol will ensure that the Trust promotes effective working practices with partner agencies, such as the police, and the Trust can demonstrate its continued commitment to meeting statutory obligations imposed by current legislation and adopts best practice to maintain a secure and safe environment for patients, service users, visitors and staff.

It should be recognised that the majority of guidance within the Protocol has been developed in line with direction issued through current Trust Policy, the Department of Health (DoH), NHS Protect, the Association of Chief Police Officers (ACPO) and the Crown Prosecution Service (CPS). Where guidance has been sourced through other Partner Agencies all such information will be referenced accordingly.

Information, guidance and direction contained within the Protocol will also ensure that the Trust meets its contractual obligations in relation to compliance with Security Management Standards for Providers issued through NHS Protect. Such relevant standards are listed below:

Standard 2.2Local Memorandums of understanding, concordats and agreements are in place with the Police and the Crown Prosecution Service (CPS) to help protect and secure NHS staff, premises property and assets. This can be evidenced.Standard 2.6All staff know how to report a violent incident, theft, criminal damage or security breach. Their knowledge and understanding in this area is regularly checked and improvements in staff training are made where necessary.Standard 2.7All staff who have been a victim of a violent incident have access to support services should they require it.Standard 3.2The organisation has arrangements in place for post incident learning in relation to a) security breaches/incidents b) acts of violence c) thefts d) criminal damage and a mechanism for feeding this back into policy development.Standard 4.1The organisation is committed to applying all appropriate sanctions against those responsible for acts of violence, security breaches, theft and criminal damage.Standard 4.2The organisation has arrangements in place to ensure that allegations of violence, theft and criminal damage are investigated in a timely and proportionate manner and these arrangements are monitored, reviewed and evaluated.

The application of the guidance and direction detailed within the Protocol also aims to achieve the following:Reporting incidents to the Police as they are occurring or before they escalate

Trust staff understand the rationale for requesting an emergency and/or priority response from Police Services

Trust staff and Police Services understand each other’s powers, duty of care and responsibilities where Police Officers have been deployed

The Trust works effectively with Partner Agencies

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Reporting incidents to the Police after they have occurred

Trust Staff know how to report an incident of assault and/or criminal activity, either through internal procedures or to the Police

Police Services and other partner agencies are aware of their responsibilities once an incident(s) of assault and/or criminal activity has been reported to them

Appropriate support mechanisms are afforded to Trust staff who are the victim of an assault and/or criminal activity

Appropriate Trust support is provided to Police Services to inform the investigation process following a report of assault and/or criminal activity

The Trust works effectively with Partner Agencies

2.0 Definitions

Through analysis it has been established that the majority of incidents which are reported to the Police by the Trust, either for a request for Police response or as a post incident formal report, are related to assaults against the person. Other incidents which are routinely reported to the Police include theft (including burglary), intruders to Trust premises and/or damage to property. To ensure clarity is maintained throughout this Protocol the following definitions of these types of incidents apply:

Physical Assault – The intentional application of force to the person of another, without lawful justification, resulting in physical injury or personal discomfort.

Non-physical Assault – The use of inappropriate words or behaviour causing distress and/or constituting harassment.

Theft of Personal or Trust Property – the dishonest appropriation of property (Trust or Personal) with the intention of permanently depriving the other of it

Burglary – A person(s) who enters a building (by use of force or otherwise) as a trespasser with intent to (or attempts to) steal anything within the building

Intruder – any person who knowingly enters Trust premises who is not authorised to do so Damage to Property – to wilfully (with intent) damage or deface Trust or personal property

It should be recognised that when such incidents are reported to the Police the vast majority of these reports are made after the incident has actually occurred and only a very small number of incidents of this type would necessitate an emergency Police response and/or Officer Deployment.

3.0 Rationale for Police Emergency/Immediate Response and/or Deployment of Officers

It is extremely important that Trust staff are aware of the nature or type of incident which would justify an emergency response and officer deployment from the Police. It is equally as important that when Police Officers have been deployed to Trust premises/services Trust staff and attending Police Officers are fully aware of each other’s responsibilities to manage such an incident.

The following information will detail the typical type of incident which could justify Trust staff contacting the Police and requesting emergency deployment of Officers to Trust premises and guidelines and direction to be applied by all parties concerned on such deployment.

3.1 Type of Incident Justifying an Emergency Response and Police Officer Deployment

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Through incident analysis it has been identified that Trust staff vary rarely call for, or rely on, police intervention as a preventative or controlling measure for the management of assaultative behaviour or criminal activity. It is however accepted that there will always be occasions where emergency Police intervention may be required to assist Trust staff with the management of any given incident where staff cannot effectively maintain safe and/or adequate control of a situation through the application of recognised Trust internal management procedures. Such emergency police assistance and intervention would be deemed justifiable in such circumstances where serious harm has been caused to a member of staff, service-user or member of the public and/or there is a credible and imminent risk of serious harm being caused to a member of staff, service user or member of the public. Such circumstances would be particularly pertinent to the following types of incidents:

Incidents involving an individual(s) brandishing an offensive weapon(s)Any article made or adapted for the use of causing injury or harm to another person(s)

Serious or sustained/prolonged physical assault against another person(s) (including sexual assault)Any incident where an individual(s) has committed a serious physical assault (resulting in serious harm) or is in the process of committing a serious and/or prolonged/sustained physical assault against another person(s)

Where there is an actual occurrence of hostage taking and/or there is a credible imminent risk of hostage taking The act of seizing or holding an individual(s), against their will and without legal authority, for a particular motive

Prolonged/sustained period where an individual(s) has caused significant damage or is in the act of causing significant damage to property (including arson)Any incident where an individual(s) is in the prolonged/sustained act of causing significant or serious damage to property

An intervention where a shared risk management plan has been developed and implemented for an agreed response from the Police to a specific type of incident as identified in the Patient Treatment PlanAny incident where evidence and/or intelligence has identified that there is a credible risk of escalated and/or offending behaviour occurring or re-occurring and a Police response is required

The above list is not exhaustive and other types of incidents may necessitate Trust staff to request police assistance. However it should always be recognised that Police Officers should only be deployed in exceptional circumstances and attending Police Officers do not have powers to assist Trust staff as a preventative or controlling measure, to manage a clinical situation, to administer drugs or medication or to transfer a patient from one setting to another. In these circumstances there should always be other clinical strategies and direction in place to manage such situations and/or occurrences. The Police will then be assured that any call for attendance from the Trust is one requiring immediate deployment in a situation which staff are unable to manage safely without assistance.

3.2 Procedures for Trust Staff to call Police for a priority/emergency response

When calling for police assistance, staff should be very specific about the incident and the associated risks and impact factors, using descriptive language and giving appropriate information in order to enable police control to send an appropriate response. On receipt of such a call Police control staff will conduct a dynamic risk assessment/grading on the phone to assess the nature of the incident and what appropriate response is required.

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In all cases where a priority/emergency response is required from the Police Trust staff should contact them via 999

3.3 Procedures for Trust staff and attending Police Officers on their deployment at scene

On all occasions where Police attend the scene the Officer in Charge will make personal contact with the member of staff who is the designated nurse/person in charge (or Nominated Deputy). This member of staff should have knowledge of the circumstances leading up to the incident, the current status of the incident and the following information related to the clinical and/or medical presentation of the service user(s) and/or other persons involved.

Current status under the Mental Health Act (detained or informal) Current clinical presentation Current physical health/medical presentation (including any known underlying physical

health and/or medical conditions) The risks posed (to the service user and to others) Previous history of violent and/or assaultative behaviour towards others Previous history of self-harming behaviour Recommended ways of approaching the individual (including when to stand off) An understanding of the Trust’s duty of care and responsibilities in relation to the physical

health and clinical presentation of the patient(s) or others involved during any Police intervention

Where ever practicable before any Police intervention the Officer in Charge and nominated member of Trust staff will always discuss and agree the type and/or level of intervention required which will include an agreed exit strategy for the Police Officers involved. However it should be noted that in some circumstances it will not always be practical to agree such strategies before Police intervention where there is an actual occurrence of serious harm being caused or there is an immediate/imminent risk of serious harm being caused.

3.4 Powers and Duty of Care of Trust staff and Police Officers

Police Officers have a duty to respond to incidents in Mental Health/LD Settings, including incidents where the suspect is an in-patient, either informal or detained under a section of the Mental Health Act 1983. The typical type of incident where a Police response may be required has been previously highlighted in Section 3.1 of this Protocol. However it should be recognised that Trust staff should always use their professional judgement when requesting an emergency Police response on a case to case basis and based on the circumstances and severity of the incident.

Where Police have responded to any given incident the principle duty of care towards the patient will always remain with the Trust and the appropriate clinical team and every attempt will be made to keep the patient within the in-patient environment, particularly those who are detained under the Mental Health Act. However it should be recognised that that as a direct consequence of the incident there is a potential need for the patient to be removed to Police Custody a strategy meeting with the Police, the Responsible Clinician and other appropriate clinicians/healthcare professionals should always be held to determine agreed outcomes.

In such cases, wherever practicable, a Significant Decision Capacity Assessment, in Line with Trust Policy on the Use of the Mental Capacity Act 2005, should be undertaken by the appropriate clinician before the patient who is suspected of committing the offence is interviewed by the Police. Such an assessment will inform the patient’s fitness to be interviewed.

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All Police interviews of patients who are suspected of committing an offence will always be undertaken in accordance with the Police and Criminal Evidence Act (PACE) 1984. 3.5 Physical Interventions and/or Use of Equipment (Cuffs, Baton, PAVA Spray & Taser) by Deployed Police Officers

Police officers should not routinely be involved in physical interventions and/or restraint applied to a patient, and as previously highlighted they do not have powers to restrain a patient for the purposes of a clinical intervention, to administer drugs or medication (Rapid Tranquilisation) or to transfer a patient from one setting to another. In such circumstances Healthcare Professionals will continue to be responsible for the treatment, care and well-being of the patient. However it should always be recognised that deployed Police Officers may need to assist to restrain a patient in exceptional circumstances where serious harm has been caused, and/or there is an imminent risk of serious harm being caused, to either the patient or others.

It should also be recognised that Police Officers have a specific set of tools at their disposal to help them manage incidents or offending behaviour. These include the use of cuffs, batons, PAVA spray and taser. It is important where possible for Trust staff to brief Police Officers on their arrival of any physical, medical or clinical factors which are relevant to resolving the emergency situation which has led to the Police being called. Police officers will consider this information in deciding how best to resolve the situation, where necessary using their equipment in line with the training they have received.

The Police will always assume full responsibility for their actions where such control measures are utilised. However, due consideration should be given by Trust staff to recognise that Police Officers may be required to deploy a high degree of force to manage a situation they have been called to which on occasion could seem to be disproportionate to that which Trust staff routinely utilise. Regardless of the level and/or type of Police intervention the principle duty of care for the physical health of the patient(s) involved will always remain with the Trust’s Clinical Team in these circumstances.

3.6 Post Incident Review Procedures

Following deployment of Police resources to deal with emergency incidents within Trust premises, it is essential that at the conclusion of the incident Police and Trust staff hold a joint review to consider what potential offences have occurred, the current clinical presentation of the patient involved and Police exit strategies. A joint decision should then be made on the best course of action to ensure the safety of the patient and other persons involved and that the risk of further offences being committed is managed appropriately.

Where deemed appropriate, based on the severity of the incident, consideration should also be given to convening a further formal post incident partner agency case review to give the opportunity for all those involved to review the circumstances of the incident to ensure effective learning outcomes are established. Such a review will be facilitated through the Trust’s Security Management Specialist (or nominated deputy) and the Local Police Inspector (or nominated Deputy) and should take place, wherever practicable, no more than 7 days after the incident has occurred.

4.0 Post Incident Reports to Police Services (where a priority/emergency response is not required)

The Following Information will highlight procedures to be undertaken by Trust staff when reporting incidents to the Police of assault against the person and/or other criminal activity instigated by

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patients. It should be noted that all such incidents should also be reported through the Trust’s Incident Reporting Systems. Further information within this section of the Protocol will also detail the responsibilities of the Police to undertake effective investigation into such matters and procedures for Trust staff to assist with the investigation process.

4.1 Rationale for Post Incident Reporting to the Police

The Trust will always support the reporting to Police of assaults against the person and/or other criminal activity instigated by patients where the incident was not related to clinical/medical factors at the time of the incident occurring. For incidents of assaults or other criminal activity which are considered to have been related to clinical/medical factors, the decision about whether to report to the police may be made jointly by the staff member(s) involved, the Responsible Clinician (or nominated deputy), other senior clinicians and the Trust’s Security Management Specialist (or nominated deputy).

However it should always be recognised the victim of an assault or criminal activity can always make a report to the police if they wish, and should be supported by appropriate Trust staff in doing so. Such a decision should be made on a case-by-case basis, but it may be appropriate to report an incident to the police if (among other factors):

The Responsible Clinician or nominated deputy are of the opinion that the assault was not related to clinical/medical factors

A possible crime may have been committed The assault is considered serious Significant injuries were sustained in the assault The staff member(s) involved are in favour of reporting it to the police It would help the individual take responsibility for his/her actions and understand real

consequences It is considered beneficial to the service user with regard to effective recovery and treatment

/risk management plans It is beneficial to establish a forensic history for the service user to inform future clinical

assessments and treatment/risk management plans It is considered necessary for future protection of the individual, staff and other service

users that the incident is dealt with via the criminal justice routeMental disorder is not an automatic bar to police investigation and subsequent prosecution . It should be stressed that a diagnosis of mental disorder, or the fact that a suspect is detained under the Mental Health Act, does not routinely mean that investigations by the Police should not be undertaken. In addition to this it should also be recognised that on receipt of a Police investigation case file the CPS will always apply Home Office guidelines on how to deal with mentally disordered offenders and follows the Code for Crown Prosecutors and the CPS Legal Guidance on Mentally Disordered Offenders.

4.2 Process for Post Incident Reporting to the Police

Where a decision has been taken to make a formal post incident report to the Police (where no immediate response is required) such a report will usually be made by the victim(s) of the incident, with appropriate support from senior clinicians/service leads within the Division, Directorate or Team where the incident occurred. Where the victim is unable to make such a report the incident should be reported to the Police on behalf of the victim(s) by a senior member of staff from the service area where the incident occurred or the Security Management Specialist (or nominated deputy).

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Information to be given to the Police when reporting the incident should include the following information:

Name and designation of person reporting the incident Incident type – e.g. physical assault perpetrated against a member of staff by a patient Day, date, time & location of incident Details of the instigator of the incident – to include the following information:

Name & Date of Birth Current status under the Mental Health Act (detained or informal) Name of Responsible Clinician Current whereabouts – e.g. is the patient still on the Ward following the incident Current clinical presentation and details of any immediate risk the patient may present

following the incident Details of the victim/injured party to include the following information:

Name, address & date of birth Injuries sustained as a result of the incident – e.g. bruising, lacerations etc. Contact details for future contact by Police – e.g. home and/or place of work

Details of any witnesses to the incident to include the following information: Name, designation and work base

Once this report has been made to the Police a Log Reference Number should be obtained from the person making the report. This information should always be included in the internal incident report. If an incident report into the matter has already been submitted and therefore cannot be accessed to update this information then the Security Management Specialist or member of the Risk Management Team should be advised and the information will be uploaded into the appropriate report.

Further relevant information relating to the incident may be recorded on the patient health record. Such information should be recorded by a senior clinician involved in the care of the patient involved but consideration should be given to ensure that this information is not subjective in relation to the clinical condition and/or capacity of the patient at the time of the incident occurring. Ideally this information should record the presentation of the patient prior to, during and after the incident and any factors which contributed to the incident occurring.

4.3 Police Investigation Process

On receipt of the Report the Police will be responsible for appointing an Officer in Charge to investigate the matter. On appointment the Officer in Charge will make contact with the Trust’s Security Management Specialist (or nominated deputy) to agree the terms of reference and practical arrangements for the investigation process.

Where appropriate for offences reported to the Police which are not considered to be of a more serious nature (e.g. physical assault resulting in minor harm or a non-physical assault which has resulted in the victim to feel harassed, alarmed or distressed) consideration could be given by dealing Police Officers and/or appropriate senior Trust staff in applying restorative justice processes to deal with the matter. Such occurrences should be considered on a case to case basis and this option should only be applied with the full consent of the victim who has made the complaint. These processes will include the following:

Community Resolution Orders (facilitated through the appointed Police Officer in Charge) Acknowledgement of Responsibilities Agreements – ARA (facilitated through direction issued

through Trust Security Management Policy)

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A record of the application of Restorative Justice Processes will be recorded through appropriate Police and Trust systems and may be referred to where individual patients have re-offended and subsequent reports have been made to the Police.

In circumstances where a decision has been taken to produce a case file to the Crown Prosecution Service for potential prosecution the following arrangements will be made for the Officer in Charge to gather appropriate evidence:

1. MG11 Witness Statement to be taken from Responsible Clinician (or nominated deputy)2. MG11 Witness Statement to be taken from Victim/Injured Party3. MG11 Witness Statement to be taken from any witnesses to the incident4. MG11 Witness Statement to be taken from appropriate senior member of clinical staff

involved in the care of the patient involved – e.g. Ward Manager, Charge/Staff Nurse5. Disclosure of other appropriate evidence in relation to the incident – including Victim Impact

Statements

Arrangements for these statements to be given will be made through consultation with the Officer in Charge, the appointed Responsible Clinician, the victim/injured party, appropriate witnesses and healthcare professionals and the Trust’s Security Management Specialist (or nominated deputy).

The following information will detail the information required from each of the above to inform the Police Investigation Process.

Responsible Clinician

The patient’s Responsible Clinician (or nominated appropriate deputy), on request, will give an MG11 witness statement to the Police to provide the following information:

What is the patient’s legal status under the Mental Health Act 1983 The purpose of the patient’s most recent admission and/or clinical diagnosis Are there any clinical barriers to prosecution? An outline of the risk management plan, should a prosecution not occur Any known previously unreported offending, relevant to the reported incident Information concerning any continued risks of offending behaviour occurring

Victim / Injured Party

The Victim/Injured Party, on request, will give an MG11 witness statement to the Police to provide the following information:

A factual account of the circumstances leading up to the incident A factual account of the actual incident Details of any injuries sustained as a direct result of the incident (including any photographic

evidence) A factual account of what happened following the incident

Witnesses to the Incident

Any witnesses to the incident, on request, will give an MG11 witness statement to the Police to provide the following information:

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A factual account of what was witnessed leading up to the incident A factual account of what was witnessed during the incident A factual account of what was witnessed following the incident

Senior Member of Clinical Staff (other than the Responsible Clinician) Involved in the Care of the Patient

A Senior Member of Clinical Staff involved in the care of the patient involved, on request, will give an MG11 witness statement to the Police to provide the following information:

The presentation of the patient prior to the incident occurring The presentation of the patient following the incident occurring An overview of any risk management plans implemented to manage the risks associated

with potential offending, disruptive and/or assaultative behaviour

Where any further written information in relation to the health records of the patient involved is required to inform the Police investigation process then on all occasions the Police should make a formal request for such information in line with direction issued through the Trust’s Health & Social Care Record Policy & Strategy – Section 8 Access to Records.

Trust staff should be aware that on no occasion should written copies of patient health records be disclosed or handed over to the Police as part of initial/routine investigations into matters of assaults against the person and/or criminal activity instigated by patients. 4.4 Police Interviews of In-patients Suspected of Committing a Criminal Offence

Where a decision has been taken by the Police to interview an in-patient who is suspected of committing a criminal offence every attempt should be made to facilitate such an interview in the Hospital environment, particularly those patients who are detained under the Mental Health Act 1983. However it should be recognised that that as a direct consequence of the incident there is a potential need for the patient to be removed to Police Custody a strategy meeting with the Police, the Responsible Clinician and other appropriate clinicians/healthcare professionals should always be held to determine agreed outcomes.

In all cases a Significant Decision Capacity Assessment, in Line with Trust Policy on the Use of the Mental Capacity Act 2005, should be undertaken by the appropriate clinician before the patient who is suspected of committing the offence is interviewed by the Police. Such an assessment will inform the patient’s fitness to be interviewed.

All Police interviews of patients who are suspected of committing an offence will always be undertaken in accordance with the Police and Criminal Evidence Act (PACE) 1984.

4.5 Monitoring Investigation Progress and Outcomes

The Trust’s Security Management Specialist (or nominated deputy) will be appointed as the Single Point of Contact (SPOC) on behalf of the Trust to liaise with the Police and appropriate members of staff during the investigation process. The Trust Single Point of Contact will responsible for arranging all Police contact with members of Trust staff during their investigations and will be able to update those concerned on the progress and outcomes of the investigation. Where Trust support is required for staff to give statements and information to inform Police investigations into the matter the SPOC

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will liaise with the Officer in Charge and appropriate clinical teams to ensure such support is afforded.

It should also be recognised that the Trust, via the Security Management Specialist, have a legal obligation to report assaults and other offences against NHS staff to NHS Protect. This includes an obligation to report the outcome of any police investigation or criminal prosecution. In line with this statutory direction the Police are required to provide the following information to the Security Management Specialist to update on investigation progress and outcomes:

Details of any person arrested (e.g. name, date of birth and address) Details of any bail conditions imposed which relate to the protection of NHS victims or

witnesses or restrictions on attending NHS premises Details of any non-court disposal imposed or cases where no further action is to be taken Details where any person is charged or summonsed Details of the initial court hearing.

Once a suspect has been charged, information on its progress will be sought from the Witness Care Unit (WCU) and not the Police and in line with statutory direction the WCU are required to provide the following information to the Security Management Specialist in such circumstances:

Details of all court hearings (i.e. date, time, location and purpose) Details of NHS witnesses required to attend and give oral evidence Outcome of court hearings Details of sentence, financial orders and any conviction ancillary orders Details of any appeals

To ensure that the above information is disclosed as previously directed the Security Management Specialist (or nominated deputy) will arrange for a Victim Consent Form to be completed and forwarded to the Police Officer in Charge to inform the investigation process.

Partner Agency Signatories

Partner Agency Name Designation Signature

Therèsa Moyes

Executive Director of Quality & Clinical Performance / Security Management Director

Giles Perry Trust Security Management Specialist

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Nicholas Aronin

Area Security Management Specialist – West Midlands

Andy Rogers

Director of Operations (Security Management Director)

Jon Drake Assistant Chief Constable

Garry Forsyth

Assistant Chief Constable

Crime

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