An NHS Police Service

Here’s a thought: amidst all this debate about arresting drunks from A&E, demands on policing connected to the operation of our National Health Service, the particular demands and complexities connected to our mental health system – set up a police force connected to the National Health Service and makes its officers accountable to the NHS and patients in a way that other forces are accountable to the broader public.

Let’s debate “an NHS Police Service” – there are various problems and precedents to refer to here and some statistics worth chewing over, but I want to get my excuses in early: this is a quick BLOG just to stir some debate, not a costed policy proposal or a formal research work!  I’ve spent about an hour and a half on this, whilst cooking dinner and half-watching the telly, so let’s get that clear at the start!

  • The NHS has a ‘population’ of millions
  • Over 1.4million employees.
  • They have 1 million patients every 36hrs – of course, how many patients bring a friend or relative? Or three?!
  • So every single day the NHS probably has over 2 million ‘in’ it – more than very many geographical police forces.
  • There were 21 million unscheduled A&E attendances with all the security implications that come with a lot of them.
  • There were over 1 million people in contact with the mental health system.

A typical security budget for a large teaching hospital would be around £1.5m per annum for ‘revenue’ costs, ie, security and related staff.  With 150 similar trusts, that’s well over £225m.  You can then add-on various other kinds of NHS trusts, like mental health trusts and their security costs as well as the overarching organisation NHS Protect (who employ hundreds of people and have a budget over £11m) to see that the NHS is spending more money per year on security issues that many Chief Constables are spending in some large policing areas.

For example, Northumbria Police had an overall budget for 2012/13 of approximately £300m.  They employ over 3,750 full-time equivalent officers and police a (resident) population of 1.5 million people with many more travelling to work and play in the area every day and every weekend.  They are the sixth largest police force in the country, one of the metropolitan areas outside of the capital.  Just to give you a sense of the “NHS Police” comparison idea, I’m going to continue to compare that force.  I could have equally chosen another force – there’s no specific reason why Northumbria as opposed to Merseyside, West Midlands or Greater Manchester, for example.

CRIME AND DISORDER IN THE NHS

So what about NHS workload and demand? – is there enough to keep a police force busy?!  Well, in 2013/14 there were 68,683 assaults recorded by the NHS.  There were numerous thousand other incidents of threatening behaviours (stopping short of a physical assault), harassment, criminal damage, etc..  To put this into context with our ongoing comparison to Northumbria Police, they recorded 10,928 violent assaults for their whole force area, with another 1,624 sexual and robbery offences.  So our NHS is self-recording nearly seven times as many violent crimes as our sixth biggest English police force.  Even allowing for under-reporting to the police, that is still going some!  I’ve written previously about assaults on NHS staff and noted that 7o% of those recorded by the NHS are experienced in our NHS mental health sector.  The majority of the rest are in the ambulance sector and emergency department settings.  It’s comparatively easy to target violent crime in the NHS.

Overlaps with the ambulance service would be very easy to manage – how about a police officer posted with certain first responder vehicles, able to go to those calls where ambulance colleagues want support in light of conflict and confrontation on previous occasions?  We know that many areas have played around with joint response unit type concepts, either on an ongoing basis (like in the London Ambulance Service) or for specific events (like New Year’s Eve) in certain big population areas.  It would open a whole new debate about street triage – what that service is for and who is supporting who, doing what?

Of course, you’d have to ask what ‘health’ related work you’re separating off.  Home office forces would still, inevitably, have to make decision to instigate use of section 136 of the Mental Health Act for example.  Such decisions occasionally are necessary in health settings, like A&E, but are more often taken in streets of our country and in other kinds of public place, away from the NHS.  But the NHS having an ‘internal’ police service, perhaps they could call upon them to support Mental Health Act assessments in private homes, given the specialist health nature of that work?  There could be arrangements set out between the NHS Police and Home Office forces about managing overlaps – just as there are with other law enforcement authorities.

PRECEDENTS ALREADY SET

This is not such an untested, pie-in-the-sky idea.  British Transport Police do exactly this for a nationwide ‘population’ and infrastructure, partially funded by Network Rail, which we must remember is a private company.  There are other, specialist police forces around like the Ministry of Defence Police who provide policing and security functions at various locations for specific purposes.  Somebody, somewhere, at some time has decided that those responsibilities cannot sit with local geographical police forces.  Looking further afield and you see in the City of New York that the Health and Hospitals Corporation, who run various public hospitals, have their own police force.  In addition, the State of New York has police specifically aimed at support the public mental health system and the public learning disabilities system.  Such fragmentation is a hallmark of US policing, incidentally!

We seem to be wrestling at this point in history, with how and whether to distinguish between the role of the public police and the public health system.  I’ve remarked before that it was unheard of during my time as a police constable for NHS staff to call for the prosecution of a patient who had a mental health problem.  Far more frequently, staff would call for the arrest, removal and prosecution of drunk people, especially where they had assaulted NHS staff or threatened to do so.  You should bear in mind that when I first joined the police I worked an area with one of Birmingham’s major A&E departments as well as a psychiatric facility that experienced a lot of disturbances.  Within a decade, calls for the prosecution of psychiatric inpatients had swung to the other extreme and requests were often made for prosecutions that were, frankly, quite ridiculous.  I’ve touched on the NHS statistics for assaults and if you did not click the specific link and look at some of the numbers, I’d encourage you to do so.

On page 10 we see assault data for the mental health sector that clearly show how confused we still are about distinguishing crime from health issues.  Let’s look at three London mental health trusts, which all border each other, incidentally —

  • Oxleas – 474 assaults, absolutely NONE of them “involving medical factors”.
  • South London and Maudsley – 1,192 assaults, 477 (40%) of them “involving medical factors”.
  • South West London and St George’s – 387 assaults, absolutely ALL of them “involving medical factors”.

What were the chances of that, all other things being equal? … we don’t know what’s going on, do we?!

We know in many cases that the NHS think they’re not getting what they want from public policing.  Whether this is right or wrong, fair or unfair, I’ll let you decide as it will rest on weighing up and prioritising much that is subjective.  What I do know, is that an NHS with its own police force could target its policing resources to its priorities and could devise training that addresses the particular issues of policing healthcare related incidents.  We know there are plenty of occasions where the NHS and the public police are bouncing off each other, mis-understanding each others purpose and point.  We know that dedicated police activity in hospitals is often welcome, that some NHS trusts are currently paying (at least in part) for the posting of police officers to hospitals.  Some have already found that where they do that violent assault and staff sickness reduce to such a degree that it more than pays for itself. We also know, that amidst budget cuts of the size we’re currently seeing, some Chief Constables are struggling to justify this against all the other priorities and demands being faced by the police.

But I wonder whether this is something we should discuss? – if I’ve mined stats in 90 minutes that shows a budget to rival that of Northumbria Police is going into security issues in our NHS and that they are not happy with how that all too often does not or cannot connect to public policing, I’ll bet there are yet more costs for NHS trusts that I’m not even beginning to contemplate yet and overlaps we could better manage.  Is healthcare such a specialist dimension to police work that it warrants a different approach to what most people still consider to be a prized national asset, bearing in mind that we have taken this approach in other areas of our national life.  You could imagine a Chief Constable on the management board of NHS England, Chief Superintendents covering very large geographical commands with their management teams to support them and an inspector would oversee the policing operations of a number of hospitals or other functional responsibilities, being known as the lead partnership figure in their areas.

I can already see that such an approach would have many significant drawbacks but I am, deliberately, not going to touch upon or mention any of them.  I’m just going to let the idea sink in and I’ll return to this topic some weeks from now!  Nothing in this BLOG post should be used to infer anything about what I think about all of this … I’m just throwing it out there as I now have a real world to get back to!  There is so much more that could be said.


IMG_0053IMG_0052Winner of the President’s Medal from
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


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8 thoughts on “An NHS Police Service

  1. hi just read your blog very interesting about the NHS having their own police force though i am not a police officer i think it’s a good idea. Just had a look at the statics of staff being assaulted by the general public, just wondering about the other way around on the statics of staff assaulting the general public is that ever recorded just interested to see about openness, honesty and transparency the other way around.

  2. I started reading this slouched in front of the tv. Withing the first few lines i was sat up and a light bulb flicked on above my head. I think this idea has some potential for alleviating stresses on the NHS and the various police forces. I hope somebody does make a formal research project from this and its pros and cons identified. The comparisons you draw are cirtainly interesting and are superficially compelling.

    Im looking forward to seeing you come back to this.

  3. Michael thank you for opening what could be a very interesting debate. I can see lots of merit in exploring an “NHS Police”, as you identify there would be many challenges and potentially some disadvantages to what you suggest but it certainly merits further consideration.

  4. What a great idea. I work within the NHS Protect arena now and then and think that their remit could easily be extended to assist police officers in the investigation of crimes. We often take statements on behalf of overworked officers who simply haven’t got the time to do so. Partnership approach is the way forward. It’s also interesting to see how different security officers working within the acute hospitals manage drunk individuals. Those who are paid a higher wage, trained effectively, and maybe even provided certain PPE such as handcuffs (with the relevant training programmed) are far less likely to lose control of incidents and call for police assistance than minimum wage guards with little to no training and only a fluorescent jacket at their disposal.

  5. Having served in a Military Police organisation and a Non Home Office Police Force (trained to Home Office Standards), it has worried me a lack of understanding shown by many, of the different issues of Policing in certain unique or specialist areas is never taken too seriously. An awful lot of snobbery comes from some, about not being a ‘proper’ force or unit.

    There is a lot of regret it seems that the Policing levels in the Royal Parks, has gone down since the Met took over (not due to the Officers, more due to the lack of them). Do they Met really have the time to focus on the 8 Royal Parks (and associated properties/land) that are spread across London. After all, they are just Parks, what happens in a Park?…Well what with a history of Assassination Attempts, Kidnap attempts, Terror Attacks, very large Public Order situations, Public Military Events etc etc not a lot it would seem.

    The British Transport Police has stepped up to being an Armed Police Force again (they were one of the first Armed Police Forces) and is sadly much needed. If our Airport Police have to be armed it is only a matter of time that the now international rail services may have to be as well.

    To me all the talk of National Infrastructure and the like seems to have missed the chance to seriously consider who should be policing us and where. Who is protecting the National ‘Critical’ Infrastructure?

    The BTP could and should in my view take on (as their name suggests) all Transport issues, from Trains, Planes and (possibly) Automobiles (Hell of a game…). So forces such as, the Port of Dover, the Mersey Tunnels, and all the other forces with such responsibilities come under one roof. So in theory one call to BTP HQ could help close the country (to a point) to someone trying to leave or enter.

    The MOD could take on policing of all Government installations not just those of the MOD? So research, communication and other key points could come under them.

    The Civil Nuclear Constabulary take on ‘All’ Nuclear facilities, it strikes me as odd that some venues have no armed Police presence yet others do?!

    As for an NHS Police force, why not, the larger venues and cities could easily justify it, given the amount of people they see, their locations, the very special nature of some sites be they research or holding very dangerous individuals etc. Would all benefit from a uniformed presence.

    I used to believe one Police Force would be the way forward, but as the takeover by the Met of Policing the Royal Parks has shown, the public that is regularly policed feel they are now not seeing the number of officers, patrols, etc. As they are always been called out to assist their colleagues outside their area that they are paid by the Royal Parks Agency to Police, which is all well and good for serious incidents. But are the RPA, getting value for money currently? The Home Office are no longer helping out either it would seem and the Parks will potentially suffer.

    Where we have County forces that Police large tracts of land and look after more than one county the same will be said, we don’t see an Officer; they are drawn into the towns and cities. So why not have forces more focused on the local issues?

    In the USA as mentioned there are very diverse Police forces from the large forces like the NYPD and LAPD, to the US Parks Police, Hospital Police, Port and Airport Police etc. Even in Europe we have countries with both National Police with Local Police. I for one don’t want to see County Forces go, not anymore, as I would see less of my local PC’s. A national force for National issues maybe, but local/specialist Officers who know their patch (be that a Railway or Power Station, a Park, a Port or a Airport) and care for it, can feel some sense of belonging and ownership would be much better in my humble opinion.

    We have a system that to me just needs joining up a little.

    This NHS Police Force could then take on the Fraud issues that impact on the NHS as well, or would a new Government or Public Departments Fraud team be wiser? Different units for different sectors as some Frauds are quite detailed and vary from sector to sector? But they all could come under a National Fraud team. There are staff already in place, that would need to receive warrant cards (a large proportion ex-Police Officers or experienced investigators from other sectors).

    Use the NHS Protect model with Fraud and Security strands being taken more seriously. The fraud side is often picked up by other Government Departments, but when you mention security and government it ranges from MI5 and 6 to the security guard on the door, more thought needs to be given in other sectors and more done to protect ‘our’ resources, be that the staff or the property from criminal elements. The NHS actually leads the rest in my experience. But no resting on laurels…

    Another thought why in times of serious under staffed Police, are we not considering a Police Reserve? Ex Officers and volunteers still keen and fit enough to assist in support roles in the event of a need arising from Public Disorder, Terrorism etc?

  6. This could be a Job for the MOD Police. They are used to working in defined areas and with civil servants ( read NHS employees)

  7. Joint working with police and LSMS staff is the way forward I believe around violence and aggression against NHS staff. I regularly take statements for the police in my role as LSMS, partly to speed up the investigation / prosecution process and also to get the police to act if they are not fully motivated to get involved due to mis information or preconceptions about mental health patients and the “it’s part of the job ” mentality if staff get assaulted. I can see big improvements in my area but it is a constant battle to educate NHS staff as well as police officers. We are working towards a county wide MOU with the police and I am also hoping to get the CPS on board as their involvement is crucial at a local level.
    I don’t know if we will ever get to the stage of a police service for the NHS but I believe we need to work closer and collaborate more with the police and the CPS. This will clearly lead to a better response to violence in the NHS and hopefully lead to a reduction in assaults against staff.
    Keep up the good work Michael.
    Fin Carson
    LSMS , Essex

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