A Collision of Coincidences

Do you remember where you were on 23rd December 2016? Were you one of the other nine people with me, somewhere around 9pm at a house in the West Midlands, present at or dealing with a healthcare incident that had been reported to 999? Chances are you weren’t – this probably means you don’t have the first clue why we were there, what we were doing, who rang 999 or what the context was. And yet, the Chair of the Royal College of General Practitioners told me today in a letter to The Times that to suggest there was a shunt from a GP was “disgraceful, disappointing and demeaning”. The RCGP tweet highlighting the letter denied that shunting occurs – “absolutely not the case”. (Apologies for emphasising this: the link to the letter to the RCGP’s website – the Times printed only an abridged version, which does not include the quotation on which I’ve just relied to evidence denial of shunting.)

We were not “picking up the pieces” from a GP who had pushed a job to 999 that did not need the police, based on a false and basic mis-understanding (or a blatant misrepresentation?) about the legal powers we have. This is despite the fact that I could take you to that house; I can show you a police incident record on the command and control system; I can name the police constable I was there with and we could look up the records to get the name of the mental health nurse and the three paramedics who ended up there too.  The patient’s family members will no doubt remember us being in their house so close to Christmas and the conversations we had to have with them about why the promises that had been made to them when they rang their relative’s GP were actually misinformed and why we did not have the legal authorities that they’d been told we had. And yes, we do have the GPs side of this story – it’s recorded on the 999 tape. We know they requested something that was not legally possible.

And yet, it didn’t happen – GPs don’t shunt jobs to the police at the end of their working day; and yet their phone was turned off within 15mins of ringing 999.   For the record and the absolute avoidance of all doubt: no-one is saying this is every GP in the country, that GPs don’t work hard or even this kind of thing is most GPs; nor- is anyone saying it’s only GPs who ever do this – we know it’s actually more like to be community mental health services and crisis teams who sometimes advise GPs to do so (according to a GP on Twitter who said so yesterday!). And absolutely no-one, anywhere is saying the police are perfect and don’t do similar things that also need addressing, like over-calling ambulances and inexcusable inconsistency in investigating violence within inpatient mental health settings. I’ve said so many times and I work actively to reduce it, which is why I feel entitled to call it out when it happens to us.

ISOLATED EXAMPLES?

That’s just one example, of course – I have plenty of others and I do admit to still being fairly annoyed about what happened on 23rd December 2016. I regularly use it as my example because it helps make relevant points about inter-agency shunting, about street triage schemes creating demand for the police and about the legal issues that arise from it.  But I could have given a mass-scale example about the police expending large amounts of resource on managing situations which arise purely because the NHS find difficulty in ensuring the timely admission to hospital of patients requiring inpatient admission on about half of all occasions.  This difficulty within this kind of example is believed by the Cabinet Office to occur once in every two MHA admissions from police custody.

And if you weren’t there in police custody when officers were busy reassuring, feeding, talking to and otherwise looking after and securing the wellbeing of thousands of people each year for days on end, purely and precisely because the NHS were having those protracted difficulties identifying a bed within a timescale which prevented the detention in custody becoming an obvious human rights violation (article 5), then I’m not sure how we can say that never happens either. As it happens, the figures suggest it happens 3,900 to 4,500 time a year, but perhaps they’re wrong, too?  And this is only admission from custody after ‘diversion’ from arrest: a whole other piece of work would be needed for difficulties arising from s136 detention.  If the ‘one in every two’ admissions estimate is even vaguely correct, then it’s probably another 2,500 on top of the 3,900 to 4,500 – so 6,400 to 7,000 cases a year: or 17 to 20 times every day.

Or perhaps I misunderstood what “picking up the pieces” means – perhaps when police officers are doing such things for five or six days after the legal point was reached where s13 MHA states unambiguously that an AMHP “shall make the application” is not really the police “picking up the pieces”? Maybe if the police feeling obliged to do things with their resources which would have been completed and entirely avoided, if an AMHP had been in a position to comply with s13, which may in turn have been helped if the relevant CCG actually knew about s140 MHA and had some workable policy which gives effect to its implications – maybe that’s not “picking up the pieces”?! I admit to feeling it is, but what do I know … I’m just a police officer. I don’t even have Mental Health First Aid qualification.

REACTION TO HMIC

What’s been most interesting for me this week, in response to the HMIC report “Picking Up the Pieces” is the sheer number of people telling me that things I’ve done, things I’ve seen and the professional problems on which I still work day to day, either didn’t happen or don’t amount to any kind of “picking up the pieces”. It’s made things difficult to navigate, because I don’t know how to have a discussion about this interface, for example, between the police and GPs on mental health demand if Professor Stokes-Lampard from RCGP starts with her asserting that what I know happened to me professionally on the 23rd December 2016 when she was not there, didn’t happen and that to suggest it did is ‘disgusting’. I may need some help here, because I do so vividly remember being in that house, I remember the patient and their family; I recall the frustration in the office when the call came through asking us to go somewhere and break the law; only to find that when we quickly rang back to discuss that, the GP had already turned off their phone and effectively disappeared.

Meanwhile, if you read the New Statesman, you’ll see a piece which takes a strike at the police for the fact that HMICs report fails to mention deaths in custody and excessive force. Apart from the fact that HMIC cover custody related matters separately in other kinds of inspection, the deepest possible irony here is that this is yet another territory where I would and where I do argue that the police are often picking up the pieces, albeit I would not dream of doing so without accepting that we must be able to police properly, even if we are having to undertake work that was quite avoidable and which shouldn’t have been necessary. What I say next is in no way intended to imply that the police mustn’t learn from these tragedies and do everything possible to prevent them regardless of the background to our requirement to act.

But I seem to recall the Coroner’s jury after the inquest for Sean Rigg finding that several days of neglect and missed opportunities to ‘section’ him by south London mental health services ‘more than minimally contributed’ to his death. Was in not their precise finding that if MH services had delivered appropriate clinical care, the necessity of Sean’s contact with the police would almost certainly have been averted? Was it not the case in the death of Seni Lewis that a mental health ward was busy unlawfully detaining a voluntary patient without apply in the MHA holding powers to him and when challenging behaviour occurred they were unable to mobilise nursing resources to handle it and they called the police? Did that inquest jury not also find there were basic failures by NHS staff to intervene medically and save his life?  Was then death of Jospeh Phoung in 2016 not a case where the Metropolitan Police spent almost 24hrs being unable to access the NHS in London (no ambulance attended, no Place of Safety would accept a detention under s136; A&E asked the officers to leave), before eventually a bed was found?

HELPFUL INTENTIONS

The HMIC report was trying hard to say, as far as I’m concerned, was that there is plenty of good work going on and everyone is working hard to make the world a better, safer place – see the page reference 8, 16 and 41-16; and see the headlines and the foreword.  It’s not blaming people, of any level, in policing or mental health, but criticising the overall system which anyone who knows anything about this interface understands is part evolution, part reaction, part improvised necessity – it’s not really a system at all: it’s a collision of coincidences.  We know that police services and their officers are a part of that system and do things which have wide and regrettable impacts upon the NHS, so it’s hardly a revelation to argue the reverse is also true – I spent last night on Twitter challenging a local police Federation tweet which defends the over-calling of ambulances which is precisely why I also feel entitled to suggest where I think the police are over-relied upon, often to do things beyond their legal powers and their ‘clinical’ scope.

But all this is a product of all that complexity and misunderstanding which gives us the system we’ve currently got, helped beautifully, of course, by the fact that we are policing and caring around mental health issues using mid-twentieth century laws. The fallout from this report on a widely-used mental health nursing group on Facebook shows how badly misunderstood police legal responsibilities are and I’ve spent all morning responding to those, too.  Some no-doubt excellent nurses on there had little insight in to aspects of the police role on day-to-day mental health demand, beyond that we’re involved s135/s136 and AWOL patients. And even in that example, more than one nurse didn’t realise that AWOL patients are not always the responsibility of the police (see paragraph 28.14 of the Codes of Practice in both England and Wales).

No-one can pretend the report doesn’t say what it actually does – and in case of any doubt, its a reality on the internet, easily available to us all.  It’s just saying that systemic problems mean things have now gone too far. Policing is replete with examples of officers being asked to do things they can’t legally do (use the MHA in private premises); or to do things they can’t clinically do (safe and well checks of suicidal patients); or things being forced upon them at little notice because of an obvious lack of planning and a failure to ensure legal compliance (inpatient beds pressures).  And we know that the consequence of this is unanswered 999 calls and untoward outcomes.

WE NEED TO TALK ABOUT THIS

That’s what is meant by the ‘intolerable burden’. It’s NOT that those of us with mental health problems are a burden: it’s that making junior police officers professionally responsible for things they cannot do, as above; is just plainly unfair. So why is the report adopting this more forceful, provocative tone? Well, we’ve had a number of reports, Crisis Care Concordats and other inquiries from courts and elsewhere which have tried to bring various kinds of pressure to bear on problems which are repeatedly acknowledged. It should be borne in mind that the Angiolini Review, the Adebowale Report and the Home Affairs Committee have all published documents suggesting similar things. They may not have adopted such a direct phrase as “picking up the pieces”, but they evidence things which amount to this. I suspect this report is just trying to deliberate push the envelope on this debate because, quite frankly, many of the things we’ve tried in the past, haven’t delivered the high level outcomes we all agree we need.

If we can simply disbelieve or dismiss our police inspectorate and our police service about what they see in the course of their work, we are in a quite a dangerous place. The Royal College of General Practitioners and its Chairwoman have absolutely no idea what one of their members did or didn’t do on 23rd December 2016 and I find suggestion that what I had to deal with didn’t happen and / or that it doesn’t represent pieces being picked up by the police, fairly fantastical, if not downright insulting. But I remain grateful to those healthcare professionals who have contacted me or said publicly that they recognise what this report describes, that it chimes with their clinical reality day to day and that they are grateful for any pressure HMIC’s report might bring to bear on healthcare and other system managers to improve things.  One person has even asked to know more about this, to understand the problem better.

And finally, nothing said here or anywhere else means the police are perfect and that they don’t have many things they need to do, generally and specifically, to improve around policing and mental health. We need to find a way to talk about all this stuff – difficult though that may be and especially so for some, in particular. If you think it outrageous to suggest the police are picking up pieces, listen to the examples and let’s discuss them – in real detail. You may find, as I’ve done countless times listening to NHS staff and AMHPs, that you didn’t fully appreciate the position your partners were in legally, amongst other possibilities of things often misunderstood. But many reactions have been to suggest instead of ‘blaming’ we should somewhat generically ‘work together’ … I couldn’t agree more – but we can only work together if we can agree we need to talk about everyone’s perceptions, either to sort out the problems they contain or to understand why those perceptions are predicted on misunderstanding. It means talking about really difficult issues, where no one has a monopoly on the truth and which naturally invoke emotion because we’re all protective of our own precious professions and their increasingly difficult role in serving the public.

We need to find a way to talk about this.


Winner of the President’s Medal,
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award

 

All opinions expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2019


I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current.  Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.

Government legislation website – http://www.legislation.gov.uk


9 thoughts on “A Collision of Coincidences

  1. It can be difficult for any of us who have lost somebody in police custody and found a lack of accountability to accept the Report’s positive comments about police culture relating to mental health issues. Nevertheless, I believe you are right in everything you say here and I am dismayed once again by the government’s “Yes Minister” nonsense in their only responses to the report I have heard. This can only be solved area by area I think– and yes it needs to be talked about properly.

    1. Tony, when we get it wrong: we get it *really*, *really* wrong – no doubt. And whilst I often worry and wonder about the background of police-NHS policies in the background of that, ultimately, we do get things wrong and we must fix that. Of course, the likelihood of things going wrong goes up the more the NHS put officers in invidious positions which they do in various ways. What’s been disappointing this week are the number of people who have felt it’s right to just deny that this is ever a problem. And all I could think about were all the jobs I’ve been to where I remember wondering how the hell I’d ended up there.

      More to do – in all directions, within and without.

  2. Professor Helen Stokes-Lampard is a part time GP in Lichfield, Staffordshire. As she is so convinced that there is no problem here then perhaps she should give her home phone number to staffordshire police so that thet can ring her next time this happens in Staffordshire.

  3. It would seem the good professor is only doing what all chief executives of our institutions seem to do – ignore evidence in favour of loudly emoting a defence in favour of their members.

    This woman is earning her living. I imagine she is attracting huge support from hard-working GPs, who are besieged by political bureaucracy, an imperfect medical model, predatory big pharma and patients in all of their various glories, and on the other hand, she is earning the gratitude of the GPs who are lazy and inept – as long as they are paying their annual fees, they will be protected by the RCGPs.

    I continue to be disappointed at the decline in the integrity of our institutions. P.R. has replaced facts and evidence. Why use facts and evidence when if you continue to repeatedly proclaim some fictional version of reality, people will eventually accept this as the official view? Whoever owns the narrative earns the power and secures their position. In 2018, the truth is no longer of value. Indeed, it could be dangerous.

    I might also add that, however much lip service is given to building bridges between institutions, for the benefit of the ‘customers,’ it seems to be the last thing the chiefs of those institutions would want. Such laudable actions will be viewed as taking power away from them, either directly or indirectly particularly when problems are addressed and solved.

    I should like to say that I’m not trying to disillusion you or discourage you from continuing your good work but merely trying to provide a framework so that you will see that, however annoying it is to have your evidence, and your experience deliberately misrepresented, in the end – it is not you – it is them.

    Finally, I must say that I am not a fan of some police actions, but that’s not under discussion here. Neither do I wish to denigrate the whole of the medical profession but, out of all of our institutions, I can’t think of a better one for attracting and accommodating some truly appalling people, facilitated by the public who regard doctors and nurses as saints and angels and have deified the NHS.

    Always easier to vilify or deify instead of undertaking the hard work of engaging, investigating and learning enough to be able to offer praise or criticism. I think even the professor might agree with that if she were allowed to speak freely.

    Am wishing you well.

    1. Entirely fair points and I assure you I do realise this! – but your comment helpfully reminds me of a remark I received on Twitter which I initially took as an insult, but which discussion revealed was someone else trying to help me wrap my head around things, as you helpfully have here:

      A bloke had called me a ‘failed politician’ or similar, but ultimately what he was trying to say after he explained was, “You need to remember, you are an engineer – you trying to fix something complicated and get it right. But you’re trying to engineer a problem which everyone else sees as a political problem. They’re trying to convince everyone they’ve fixed it; which is quite different to fixing it.” — wise words. 👍🏼

  4. Thanks for your thanks (it’s that time of year!) but one final thought.
    Having read so many of your posts, you seem like a highly intelligent, fair-minded and honest officer. In our present age, such qualities may not attract appreciation and reward but a profound feeling of unease, if not alarm, from a minority. Glad you got your OBE to protect you.

  5. I have to say, having read her letter, I thought fair play. At least she has come out fighting her teams corner. I can respect that, even if I don’t necessarily agree . Shunting definitely does go on though, I have numerous examples I could give, However, GPs wouldn’t be in my top ten “offenders”. Social Services and MH teams joint first place by a country mile, ambulance service then schools, with GPs following on in a distant fourth. Maybe that’s influenced by the differing geographical areas we police?

    This sort of letter is what the Federated ranks waited years for those of Supt rank and above to start firing off. However, our leadership was oft (with some noticeable exceptions) conspicuously quiet and adverse to fighting our corner. Could I see the College of Policing, as an organisation, fronting up like the Royal College of General Practitioners? Not a chance. Influenced far too much by politicians in ACPO/NPCC with far too little of the frontline’s adverseness to being pushed about. That’s one major reason why the College of Policing is not seen as representative by a large number of the actual workers.

    Why is it that this is left to the Police Inspector and their vast knowledge of MH, to raise the questions posed in these blogs? To be our Prof Stokes-Lampard? Why isn’t the senior leadership of our very own College publicly banging the table and demanding to know what the bloody hell is going on?

    So whilst I get our disquiet at being set up to fail, asked to do the impossible and to take responsibility for that which we have no legal justification in doing so, we did that to ourselves. We should have fought our corner harder and with more belligerence, rather than doffing our caps and shuffling onward in servitude. That frontline leadership should have come from the top ranks, from the beginning, not well after the shooting stopped and the poor bloody infantry have already been eviscerated.

    So I can’t really get too worked up about Prof Stokes-Lampard bearing her teeth in defence of her team. Might we not get in contact with her and ask if she wants to be a direct entry Supt? If we have to have them, we might as well recruit people with a bit of fire in their bellies, rather than some corporate yes man and their corporate speak.

    1. Dear Response Cop,
      Spot on!
      You also made me smile (which is difficult to do through gritted teeth)

  6. Am the family of someone with severe MH condition who contributes to this debate when well enough. Who is too unwell to speak now but who we would like to be heard . Along side us as the carers.Where the GP is considered really good in a London MH Trust that is frankly appalling. Even so as family as the NR we want to scream at the good GP to stop taking assurances from MH staff simply because they are NHS colleagues when abuse of practice is now so obvious and when the CCG is a GP led organization why hasn’t the practice shouted from the rooftops on each and every case they are aware of.
    Why doesn’t she and the 20 + other GPs in the practice turn up one night en masse to one of the 3 A&Es that act as HBPoS to see the state of play and the total absence of any nursing for those in MH suites. Why aren’t they pressurising the GP MH CCG lead -who is based in their OWN practice- on s140 provision. Why aren’t you as the GP taking the lead from those of us who know. NOT MH NHS colleagues who have failed vulnerable people and carers for so long.
    Our mother has been waiting 21 days for a bed as this is when us, the GP, Ambulance service, NHS 111 MH triage and police ALL pressed urgently for admission. We have been providing 24 hr round the clock care whilst every single day the community team, duty team, medical director and chief executive the CCG and NHS England have been phoned and e-mailed several times a day. The MH Trust by the GP for the last 14 days. The MH Trust can’t even be bothered to return her calls. We couldn’t manage any more. She needed a MHA assessment because they took so long she deteriorated she couldn’t see how ill she was and wouldn’t go with ambulance or police voluntarily. Who the GP surgery is told to ring by the crisis team AND the duty intake team despite us and our mother knowing they have no legal power to remove

    We shared our anger and absolute terror with external bodies and the MP and the social worker in the community team e-mailed after us begging for intervention for weeks warning she was deteriorating to say if our mother would “like” a bed then can we let her know…
    Our mother went missing over a week ago. No one has seen or heard from her . MH services are too late and the GPs still follow exactly the same pathways that have failed for years because the convention is don’t criticise the NHS. This is NOT an NHS the rest of us who work in it recognise and GPs need to put pts before their relationship with colleagues. The system is now so violent so harmful that even the review could see this. Our mother amongst other things believes she has to die to protect us from the MH Trust. Maybe the head of RCGP would like to speak to us about shunted pts before she slates those who know and like you say are actually present time and time again. Police apologise profusely to us. The NHS never. The MH Trust has never once apologised for a single failing as it simply doesn’t see what it does as failing the most vulnerable.

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