It’s Cheaper To Do It Properly

Update June 2012 >>> Since writing this article, I have been informed that the figures of people detained in police custody in my force for 2011/12 were just twenty-three … that means over 97% of people detained are going to a healthcare facility.  Greater than my wildest imaginations, frankly.

Like many forces and most public sector organisations, my force is redesigning how we deliver police services over the next few years.  There is obvious focus at the moment on budgets, costs and cuts; as well as a whole world of politics upon which I am going to focus not one jot except to say this: we all know how the public sector is looking to doing more with less, or at least achieving the same with less.  I’ll come back to this at the end.

My force have had various requests over the last year or so from individuals and organisations regarding the operation of the Mental Health Act involving the police.  Last week, you may have seen a short BBC Newsnight piece concerning deaths in police custody during which Freedom of Information Act figures were mentioned.  The BBC sought figures from every force in England and Wales on their operation of s136 Mental Health Act and details of where individuals who were arrested were taken (hospitals or police station).  It was nice to send it back saying over 90% of people detained go to hospitals, which puts us in one of the best places in the country.

It wasn’t always like this.  In 2005 when I started work on mental health issues, 100% of people detained under the Mental Health Act went to police custody as a place of safety for the want of any other options.  This was not without consequence and not without cost – measured in many different ways.

Today I dealt with two other questions from an FoI applicant for information about the ‘costs’ involved in s136 – although they didn’t say whether they meant costs measured in time or money or both!

One could look at police involvement in the operation of various parts of the Mental Health Act in cost terms.  In fact, I know forces have done this to establish how they should cut them.  They (mis)-read the Code of Practice to the Mental Health Act and said in fairly blunt terms, “We have no obligation to do X or Y or Z, so we won’t because it will save money.”  Cue: unexpected consequences both in terms of NHS reaction, public or patient reaction and other unpredicted problems of ‘failure demand’ which meant things took even longer and resulted in operating tensions, complaints and legal actions, etc..  Costs went up.

Equally, Primary Care Trusts have sometimes to declined to ensure resources for Place of Safety provision. Cue: responses from the police attempting to improvise though an inappropriate, resistant system and avoid detention in the cells; tragedies in police custody arising from failure to identify and manage medical risks. Costs went up.

Shouldn’t we just focus on doing the right thing?  Healthcare delivered by healthcare professionals, supported by the police where this involves risk, in an environment suitable to the person’s immediate needs?

I found myself many times over the last few years talking about ‘doing the right thing’ to manage medical risks and to treat people properly, as we’d want to be treated.  When I did so, I faced suggestion from many that it would drive costs up; NHS staffing things they hadn’t previously staffed, two police officers supporting a patient for hours in an NHS PoS instead of one officer or a custody assistant doing a constant watch in the cell block.  Well, even if that were true, wouldn’t it be worth it to know we’d done the right thing?

Average detention time in police cells in my force is around 12hrs; average time in NHS PoS is more around 4hrs.  One member of staff for twelve hours or two of them for four.  Do that maths and you’re still winning the overall cost argument, aren’t you?  But that’s not why you’d do it: it’s the right thing to do.

But having sat with a calculator for just fifteen minutes yesterday, I was struck by something when answering questions about money.  There is usually no focus in costing these services on costs resulting from current ‘failure demands‘.  Things like, legal actions, which have occured against the NHS and the police arising from s136.  I am confident I could show that costs to the public from high profile tragedies nationally – including criminal and civil cases; as well as Coroner’s Inquests and human rights challenges – have been over £100m.  Yes:  over one hundred million pounds.

But by focussing upon doing the right thing, it is possible to show the following for just one police force detaining 1,000 people are year under the MHA:

  • The financial costs to just one police force of doing s136 properly, is £180,000 a year less than if they were to continue doing it badly and it comes at no extra overall cost to the NHS if they think creatively about service re-design for staffing.
  • The opportunity costs to a police force of doing it properly is reprented by 25% less time spent engaged in s136 pathways and it comes at no extra cost to the NHS.
  • The additional costs to doing it badly – for example measured in terms of ‘failure demands’ (putting things right) or in terms of formally investigating complaints, court costs of all types, etc., are not normally counted but they stand at tens of millions of pounds (for one force).
  • By the time one factors in these costs from ‘failure demands’ as well as these operating costs, this equates to over fifty full time police constables.

So we can say this very confidently:  to ‘do’ s136 Mental Health Act and Places of Safety correctly is in the interests of patients to get faster assessment, more reflective of their needs in more appropriate environments with better joint managements of risks across the agencies, but that, far less importantly(!), it actually costs less to do it that way, not more.

Pleased to report: this blog was highlighted by John Seddon (Vanguard) in their System’s Thinking monthly newsletter.  Extremely grateful for that.

7 thoughts on “It’s Cheaper To Do It Properly

  1. Think you have said it all here! Its not what costs to cut its have to ensure services are fully effective……thanks again for clarification!
    “So we can say this very confidently: to ‘do’ s136 Mental Health Act and Places of Safety correctly is in the interests of patients to get faster assessment, more reflective of their needs in more appropriate environments with better joint managements of risks across the agencies, but that, far less importantly(!), it actually costs less to do it that way, not more”

  2. I work for a consultancy firm, providing professional services to a wide variety of organisations and we’re acutely aware of the cost of rework and fixing mistakes. It’s not just the simple cost of the consultant having to do the work but it’s also the loss from the consultant not being out there doing revenue generating work… a double wammy.

    It’s strange how obvious it is to us to get it right the first time and getting it right means delivering what the customer wants. The outcome? Everybody’s happy, the business has maximised it’s return and quite importantly to me, I’m not stressed!! Why is it that in the public sector this simple fact can be so lost.

    Good luck getting through to the deniers!

    1. A place of safety is not an acute ward or even a children’s ward where children are given mind altering chemicals and labelled under section – the drugs not tried and tested on children – anti-psychotics. This is a warning to other parents – also ECT and enforced drugging/ restraint goes on to force patients to take injections – also a team ruled by non medical experts can deprive a drug for several days to a non sectioned former patient to force them back into care – to deprive a drug such as clozapine is surely against the law and that goes for depriving liberty to someone not if risk to self and others whilst the team dish out all the dirt against the family – there is no transparency or accountability and the law is one-sided. It is business .

  3. If one police force, or one council department, or one NHS department, can provide better service at lower cost, why aren’t all the others asking how you did it, and then taking steps to impove themselves USING THE SAME APPROACH. I tell you why. Because managers like power and don’t like admitting there is a better way than their way, because THEY THINK THEY WILL LOOK SILLY.

      1. Sorry, I’m coming to this one a little late (five years or so… whoops!) but can I offer a different perspective? It’s not that managers want power, but more that the expectations ON managers are incorrect? We’ve just got a completely skewed understanding of management and economics in this country!

        Until a couple of years ago, I worked in a safety critical industry – one where a failure of the safe systems has life-changing consequences for usually hundreds and potentially thousands of people in a single incident. I was removed from that industry under grounds of “capacity” over mental and physical health issues – it shouldn’t be ignored that getting rid of me under my capacity to do the job was a financial one: They didn’t have to pay me any compensation and I had no comeback against them for basically destroying my mental health because of management decisions. The pressure on me, the same as everyone else, was not just to do more with less, faster, but we had to do more, with less, faster, in parallel with other projects/schemes/agencies/companies and all without lowering standards at all. That’s impossible, to put it bluntly. I wasn’t at all upset to leave the industry because I was – and remain- convinced that a major incident happening as a result of the constant cost cutting is a matter of ever shortening odds. It’s not that it might happen, but that it WILL.

        But what’s that got to do with the comments I am replying to? Put bluntly, every single manager was put under pressure to not do it “right”, but to show that they were doing SOMETHING. Every time a new manager moved in, teams were rearranged, the office was reorganised, reporting systems were changed. Why? Because the new manager was expected to show that they were “doing something”. Short term losses as a result of this were expected, but project deadlines didn’t tend to be extended, “parallel working procedure” documents were going to solve everything; apparently including three different companies needing to work on the same location’s drawings at the same time… Yet we were required to sign that the drawings we were creating were absolutely correct. The fact that a subsequent inquiry would probably identify “systematic failings” would do nothing to help someone who was paranoid every time an incident occurred that it wasn’t because of a drawing they had designed or checked and signed off. Two of our new managers tried to do it “right”. Neither lasted very long in position, before moving elsewhere, because the management layer above them were only interested in immediate cost and immediately visible results.

        That’s going off topic, though. The fact is that while yes, newly promoted managers did tend to enjoy the power a little too much, it was more that they were repeatedly forced to justify their appointment in two ways: Immediate change and the weekly report sheet. No-one cared – or cares – about the cost over an extended time, because they’re under pressure to only consider the here and now. The fact that it’ll cost another team (the same as another blue light service) money to do something is less important than the fact that it’s saved off hours and money off the first team’s budget. In context, they looked at the one officer vice two officers, but not the eight paid hours versus twelve, because it was more immediately obvious right this minute..

        People don’t want to hear that things will cost more to be done properly. They want to hear that you can do more with existing – or fewer – resources and within existing – or lower – budgets. By the time they’ve discovered the long term costs of this, it’s someone else’s problem anyway, because they’ve moved on to something else, using what they did in their previous position as evidence as to why they’re perfect for their new one.

        It requires a far greater change in attitudes across the entire populace to solve that than a single person can achieve within their tenure of position, which is why virtually no politician, or manager, will ever attempt to do so for long. They’ll pay it lip service, but soon realise that it’s “too hard” and quietly drop it.

        Sorry for the long post on a very old blog entry, but it’s still as relevant now, in my opinion, as it was five years ago – if not more so.

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