No progress on existing concerns
Readers of this blog are well aware of the ongoing crises in the prison and probation services. Yesterday’s 3rd annual report from the Lay Observers confirmed that court custody and escort services are also in a very poor sate.
The 2017-18 annual report repeats a continuing concern that a system of disconnected contracts and responsibilities for the different elements of services for escort and court custody causes significant failings. The Lay Observers found that the welfare of Detained Persons is at risk due to poor communication, delays in the provision of appropriate healthcare provision and incomplete personal data. The report raises the question whether these factors can also lead to inaccuracies in the administration of their court case, particularly when their health deteriorates in court custody.
The report identifies a number of concerns with a negative impact on the welfare of those in custody, which include:-
- Inadequate access to healthcare. There is no on site medical support located in the custody area of any court and there is inadequate provision of medication. 10% of courts do not have any form of mental health support.
- The condition of custody suites continues to fall below acceptable standards, with concerns of poor cleanliness of cells and inadequate facilities.
- The escort and court custody arrangements for children and young people facing trial is unsatisfactory. YPs are treated like adults, placed in small windowless cells and cared for by custody officers with no special training.
- Disabled people are frequently sent for trial at courts that are not accessible to them with the result that they are discriminated against and their dignity is not protected.
- Close to half of the records sent by police and prisons when handing over custodies to the Prison Escort Services (PECS) contractors are inaccurate and more than half do not give sufficient information to allow proper risk assessments of the security and welfare of the DP to be made.
In this blog post, I am concentrating on the Lay Observers’ findings relating to poor healthcare. The healthcare standard is straightforward:
It is expected that people under escort and in court custody should have access to healthcare support at least equal to a member of the public and should be given appropriate treatment required to ensure that they are able to participate effectively in the court proceedings.
However, the report details a number of common failings; most important of which is that detained people often do not have access to their medication. Detained people often do not have medication for the full day, or medication is in the person’s property but is not made available during the day or that the dispensing instructions accompanying the medication are not specific enough to allow administration. In all these cases the person receives no medication at all. It is a common misconception with custody staff and their management that the police do not provide medication and therefore do not apparently escalate issues with police (or prisons) where the medication or the dispensing instructions have been inadequate.
With a number of health conditions, such as withdrawal from drugs (including heroin or methadone), anxiety, depression and personality disorders, the result of this can be a gradual deterioration in cognitive capability during the custody day due to the distress caused by the condition which may impair the capability of the individual to participate in court proceedings.
Of particular concern, because of the frequency of its occurrence, is the apparent absence of any protocol permitting the provision of methadone to a person suffering withdrawal whilst in court custody due to failures to ensure adequate provision by the originating custody. The impact of withdrawal on a person’s ability to participate in court proceedings can be quite severe, yet no treatment other than a sedative can be supplied even if a doctor attends.
Access to medical support is another key issue. Although detained people have the right to request to see a healthcare professional, there is no on site medical support located in the custody area of any court. The escort and custody contractors are required by their contract to make suitable arrangements for a healthcare professional to be available if needed in the court custody area. The escort contractors have sub-contracted a company to provide a helpline/triage service and the provision of medical advice, which is paid for within the overarching contract with minimal specification by HMPPS.
Routine reports from custody staff outside the London area are that the response time for a doctor at court is often four hours or more with the unsurprising consequence that court custody staff rarely call for advice on supporting detained people with health conditions, simply calling for an ambulance if they have serious concerns.
The report also notes that although mental health support has improved considerably over recent years, approximately 10% courts do not have any form of mental health support.
For me the most worrying issue raised by this important report is that all these important issues were raised in the previous year’s report (and before then), yet none have been addressed in any meaningful way.