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.
Winner of the Mind Digital Media Award.