From Belfast to Liverpool – Collaboration and Coming Together

Huge thanks to our team this week for organising our successful sponsorship of the 10th annual health and justice conference in Belfast – Steven, Hannah, Jason and Mike all going above and beyond in Belfast. And an even bigger thank you to Graham, Sean, Chris, Russell and Re-an for holding the fort back in Chelmsford.

SONAR CMS also attended the Labour Party conference in Liverpool, likely the last party conference before the UK general election.

It was fantastic to see the interest in SONAR and we look forward to following up with many new friends both in the UK and Ireland.

What was striking was the common themes in the discussion in both Belfast and Liverpool.

The theme of the Belfast event was “building bridges”. The keynote speakers emphasised the importance on collaboration between health and justice and all their constituent agencies. Professor Nicola Ranger, Director of Nursing at the Royal College of Nursing, said that she had sought to challenge siloed working throughout her career. She said that health and justice teams should have “one purpose, one goal: the people we are looking after”.

Dr Mark Juniper, lead clinical co-ordinator (medicine) of the National Confidential Enquiry into Patient Outcome and Death, described how better record-keeping and medicines management were linked to reductions in drug-related deaths in prisons. Dame Carol Black, leader of several reviews of drugs policy in the UK, explained that only a joined-up effort between health and justice departments in government could enable better treatment.

Across the Irish Sea, Sir Keir Starmer, Labour leader, said that his goal was to make government “joined-up” as well as “dynamic” and “strategic”. Wes Streeting, shadow health secretary, said that a “modern” NHS should be judged on how it prevents people from suffering ill health and harm.

In my presentation in Belfast, I argued that SONAR will deliver exactly this vision of joined-up health and criminal justice. It’s the reason why the individual modules of SONAR, from police custody to prisons to release, to GPIT are all part of the same healthcare information system.

I also said that I don’t have all the answers. My hope is that the health and criminal justice community can help us design the system that best meets their needs – all supported by joined-up commissioning.

Introducing the Belfast conference, Dr Caroline Watson, Chair of the Secure Environments Group of the Royal College of General Practitioners, said that the meeting should set a “foundation of hope” at a time when health and justice are under such pressure.

The wish to collaborate and to come together seems to me a great foundation on which to build.

John White

Founder and CEO

Responding to the annual IPOC report on deaths in Police Custody

On 28 July, the latest annual statistics on deaths in police custody generated headline news. The figures, collected by the Independent Office for Police Conduct (IOPC), showed that 23 people died in police custody in 2022-23, much higher than the recent trend.

Table: Deaths in or following Police Custody

Source: IOPC, 28 July 2023

The IOPC’s acting director general, Tom Whiting, said: “Sadly, we have seen a significant rise this year in the number of deaths in or following police custody, up to 23 from 11, and the highest figure recorded for five years. While last year’s figure was particularly low, the fact we have seen a sharp reverse is concerning and raises challenges which spread well beyond policing.”

Vulnerability due to mental health

As in recent years, the majority of cases were connected to mental health and use of alcohol and drugs:

• Thirteen of 23 people who died in or following police custody had mental health concerns.
  

• Twenty-one people who died in or following police custody had links to drugs and/or alcohol.
  

• Almost two-thirds (55) of those who died following other police contact were reported to have mental health concerns.
  

• A similar proportion (55) were reported to be intoxicated with drugs and/or alcohol at the time of the incident, or it featured heavily in their lifestyle.
  

• Sixteen fatalities following other police contact related to concern about a person’s risk of self-harm, suicide, or their mental health. A further twelve people were reported to the police as missing, with a specific risk of self-harm or suicide.

Risk of ineffective collection and sharing healthcare information

We can put the IOPC data together with evidence collected by other authorities. The importance of effective information on healthcare in police custody is clear.

There have been 20 reports from coroners, for example on police related deaths since October 2021. Of these, coroners raised concerns over poor recording or sharing of health information in five cases.

NHS England publishes independent investigation reports to establish what lessons are to be learned from a case of homicide, suicide or serious harm. A key theme of concern is inadequate handovers between agencies, based on incomplete healthcare information.

The police and prisons inspectorates carry out regular inspections of police custody suites. There were 10 in 2022 and 2021. In seven of the 10 cases, the inspectorates raise concern over the transfer of information between custody and detention officers.

Improving outcomes – SONAR and Right Care, Right Person

SONAR is specifically designed to address these concerns and so to improve health outcomes. It can connect healthcare information in police custody both to NHS data and to other areas of the criminal justice system. It aims not only to improve data collection but also to remove the problems of transition and handovers.

The best way to implement SONAR would be for NHS England to commission a single electronic case management system across all 42 police forces, using the same procurement framework as those currently used for general practice and health and criminal justice (GP IT Technical Innovation Framework (TIF) and Health & Justice Information Services, HJIS2). This would integrate health information across the forces and open the door to shared information across health and justice.

Tom Whiting also emphasised the importance of providing effective mental health support for vulnerable people. The IOPC will monitor the Right Care, Right Person scheme, by which people with mental health needs will be responded by mental health professionals rather than police officers. The scheme was developed by Humberside Police and is now being rolled out nationwide.

Conclusion

This year’s statistics were a shock to all those concerned with improving healthcare in justice settings. Let’s hope they can be a catalyst for a better way forward.

John White

Founder and CEO

SONAR CMS and Resettlement

One of our motivations in developing SONAR was to bridge the gap between healthcare systems in different parts of criminal justice - to leave the silos behind. Failures of information transfer between agencies are a regular cause of serious harm as attested by coroners’ reports.

An example is the transition between prison and probation - sometimes called “resettlement”. As the Permanent Secretary of the Ministry of Justice said in June, the latest data on resettlement is “encouraging”: over the last decade, the proportion of prisoners that reoffend within twelve months has fallen from 50 per cent to 38 per cent. The question is how to do even better, and we think SONAR can help.

One area where progress is needed is access to healthcare information, which is at the heart of the SONAR offer. Writing in May, the National Audit Office pointed out that the NHS does not always share prison leavers’ healthcare records and data with outside agencies without consent, including probation services. As a result, prison and probation staff do not necessarily know whether someone has been referred for drug treatment on release. HMPPS told the NAO researchers that this can hinder probation staff from ensuring that prison leavers engage with treatment.

For the NAO, participation in drug treatment is one of the key measures of resettlement (along with employment and settled accommodation). Only 37 per cent of prison leavers with a substance misuse treatment referral were engaged in community-based treatment within three weeks of release in 2021-22, the most recent data available.

SONAR is designed to solve precisely these problems. SONAR Secure (holding healthcare information for prisons and other custodial environments) and the SONAR Release Support Hub (for people transitioning back into the community) share information seamlessly. They comply fully with NHS and criminal justice standards on privacy. The Release Support Hub is designed to support probation teams after release - for example, by flagging when an ex-offender has missed a medical or other appointment.

Levels of reoffending have fallen but the cost of reoffending to society is around £17 billion per year on the last Ministry of Justice estimate. As the NAO report said: “Prison leavers are more likely to reoffend if they are not resettled into the community, for example if they have nowhere to live, no job or other income, and have poor continuity of healthcare.” Let’s see what we can do to help.

John White

Founder and CEO