Once upon a time in a police force an inspector got a new posting – no, this was not me. He was put in charge a busy city suburb, with retail and residential areas, very demanding and diverse.
As all good inspectors do, he sought out his crime maps for the intelligence analyst and looked at his monthly, six-monthly and annual crime, broken down by crime type: robbery, burglary, vehicle crime, violent crime, anti-social behaviour, etc., etc.. Several things stood out but on the matter of violent crime, one thing stood out in particular. A specialist psychiatric facility for women and children. Very, very high levels of reported violent crime.
The new inspector asked the local neighbourhood sergeant to get a constable to look at this properly at roughly the same time as a certain HQ ‘mental health lead’ was looking at the issue of inpatient violence against NHS staff and other patients. Several cups of coffee and a few hours of very informal ‘training’ later and that neighbourhood PC disappeared into the unit with offers of ongoing advice and support from her boss and from me.
Initially not allowed to enter in uniform or wearing handcuffs, baton, CS, etc., it was a matter of building trust. The unit had a very high levels of sickness amongst staff, who often needed considerable periods off work with visible injuries and others who suffered from stress and depression at a relenting volley of crime that was effectively unaddressed. Of course, there were the standard challenges discussed in two other blog posts – here and here: why would you investigate / prosecute those detained in a secure unit for assaults, especially if those suspects were children from highly disturbed backgrounds, often involving considerable abuse of all types? What information can you share in order to do so?
The officer formulated an approach: no reported offence would receive no reaction at all; however ‘minor’ the matter, if made aware of an incident, the patient would at least be spoken to and advised or warned. Reports would be delayed wherever possible, until she was next on duty and this would allow her to respond to ensure continuity of approach. Only if there was ongoing, immediate risk that needed an emergency response would 999 be used. Even then, her ‘response’ colleagues would simply ensure that safety was restored and refer the ongoing investigation to her.
Once the certainty of a response was understood, she was allowed to ‘patrol’ what became her favourite ‘tea-spot’ in uniform. When on the ward investigating other matters, she would take time to talk to patients who had been flagged for low-level, verbal threats. She told them what she could consider doing if anyone was assaulted. She pre-empted problems. Eventually, she was allowed to move around the hospital unaccompanied by NHS staff, with a set of keys and an NHS ID badge ‘police liaison officer’. It was her ‘beat’.
She had a range of responses to crime – including for minor offences and for those cases that were highlighted by the staff as being inappropriate for formal prosecution. It involved such informal police reactions as ensuring a written letter of apology to a nurse – welcome for many reasons if the offender was a child with literacy issues. Adults were invited to repay the cost of minor damage as many people in wider society are so invited, as an alternative reparation. Some offenders received fixed penalty notices for damage – fining them £80 and some received police cautions.
In a serious cases – which were thankfully few – and some persistent cases of repeated offending where informal approaches were tried first, matters escalated to formal prosecution and significant understanding from CPS colleagues when provided with good background information from the NHS. All of this was a joint approach between the NHS and the police / CPS and as a result, a couple of s3 patients became s37/41 restricted patients because highlighted risks which had led to their original admission to hospital, were realised against staff within the unit. It became clear that they represented a ‘serious risk of harm to the public’ and prosecution ensured public protection after release by ensuring the justice system managed risk.
Very little of this involves arrest and removal to the cells, she would arrange interviews of suspects, with appropriate adults, solicitors and doctors assessments of ‘fitness to be interviewed’ inside the unit.
Guess what happened?
Violent crime reduced massively; staff sickness levels reduced massively – to a point where the worst unit in the trust for sickness is nearly one of the best. Better continuity of care for patients with regular staffing; a safer environment for all staff and patients. How much work was this? Initially, the officer said it was about 50% of her role, sometimes more. But once trust and procedure was established, it was an occasional thing that took little time at all, just regular passing attention and frequent ground-floor liaison between the agencies’ staff.
This partnership working won a National Patient Safety Award.