Policy Statement

Summary

This policy assists officers and staff to make operational decisions when responding to calls for service involving medical support, physical and mental health, to members of the public.

 

Aims

The overall aim of this policy is to ensure Police responses in respect of medical Support are proportionate and in compliance with our legal duties. It is important to be robust and ensure that police are not missing critical information that would significantly change our assessment. As with all of our calls for service, our risk assessment model THRIVE (Appendix 2) will be applied.  The Code of Ethics published in 2014 by the College of Policing requires us all to do the right thing in the right way. It also recognises that the use of discretion in Policing is necessary but in using discretion, states that you should, "take into account any relevant policing codes, guidance, policies and procedures into consideration." All Officers and staff must be aware of the content of the Code of Ethics 2014. This policy will enable contact officers and police officers within the Force Control Room (FCR) to determine the specific concern and ensure that the right person with the appropriate skills, expertise and knowledge responds and that where appropriate police officers are acting within their police powers.

 

Scope

This policy is applicable to all officers and staff This policy does not cover specific areas such as ‘missing persons’ or investigating crime, which all have their own individual guidance policies. To prevent and detect crime To keep the King’s peace, and To protect life and property

 

Chapter 1 – Introduction

1. Overview

• The police service are being contacted by private citizens to assist them or others with a medical matter, both physical and mental health.
• The police do not generally owe a duty of care at common law to protect individuals from harm, either harm caused by themselves or others.
• The police may owe a duty of care to protect persons from harm where the police have assumed responsibility to care for them, or where the police have created (directly or indirectly) the risk of harm.
• The police may owe responsibility to take reasonable steps to assist where there is a real and immediate risk to the life of a person, or a real and immediate risk of that person being subject to serious harm or other inhumane treatment. The risks of harm where a duty will arise on the police will generally, but not always, be from the criminal acts of a third party.
• This policy will provide clarity to the police and its partners on when a medical matter will, and will not, become a police responsibility to respond. The legal duties of care and liabilities towards an individual cannot be passed to the police unless the Police accept that responsibility. In such cases where responsibility is not accepted the duty of care will remain with any partner agency or individual concerned.
• This policy does not seek to avoid the police’s responsibility to deal with core policing matters.
• However, these are not medical calls that give rise to a duty to act but are simply reflections of the usual business of policing. When the police do respond to a request for medical support that should be taken as an assumption of responsibility of care for an individual.
• A request for medical support can be initiated by a private individual and the policy makes it clear that where an individual is unable due to circumstances to seek the assistance of an ambulance the police will assist. The calling of an ambulance by the Force Control Room (FCR) on behalf of someone does not create a duty of care on the police.

Chapter 2 – Authority Levels

2. Overview

2.1.             There are no authority levels within this Policy & Procedure.

Chapter 3 – Police Powers

3. Information

• Police Powers
• In accordance with what is set out above, the police will only attend a medical call for service if;

      An ambulance has been called by the person themselves or the FCR

And

      The ambulance service are unable to respond in a timely manner

And

     An Article 2 Human Rights Act risk to life exists

*Unless this threshold is reached the police have no duty to take action and will not respond.

 

Chapter 4 – Implementing the Policy

4. Overview

• In order to continue to respond appropriately to medical calls that warrant our attention, we will adopt a robust system to clearly identify them. This will include our approach to attendance and legal duty of care and thereafter our process for discharging that duty of care in a lawful manner. The following approaches will be adopted;

Call for service into the Force Control Room (FCR) for a medical matter only

• Call to attend a medical matter received in the FCR.
• FCR call ambulance as caller cannot or caller does and ambulance state no crew free. Caller or ambulance call the FCR to inform no one attending.
• If Article 2 Human Rights Act (HRA) and no ambulance available the police will attend.
• If not Article 2 HRA the FCR will escalate to ambulance and re-Thrive response.
• If no ambulance, police will not take responsibility to resolve. Ambulance informed and log closed.
• In deciding at 4.2.5 above the police will consider all the circumstances of the incident and in very serious cases of injury and for the safety and care of a person, the police can still attend following a Thrive and use of the NDM. It is expected these situations will be rare.

Call for service into the Force Control Room (FCR) for a medical matter only

• Call to attend a medical matter received in the FCR.
• FCR call ambulance as caller cannot or caller does and ambulance state no crew free. Caller or ambulance call the FCR to inform no one attending.
• If Article 2 Human Rights Act (HRA) and no ambulance available the police will attend.
• If not Article 2 HRA the FCR will escalate to ambulance and re-Thrive response.
• If no ambulance police will not take responsibility to resolve. Ambulance informed and log closed.
• In deciding at 2.5 above the police will consider all the circumstances of the incident and in very serious cases of injury and for the safety and care of a person, the police can still attend following a Thrive and use of the NDM. It is expected these situations will be rare.

Police use of S136 Mental Health Act

• Police attend mental health call for service.
• Officer at the scene calls Mental Health Services to consult.
• Officers to let the person speak directly to Mental Health Services.
• If person is unable to speak to Mental Health Services the police will do so.
• The police will always speak to Mental Health Services as well as the person to ensure correct understanding of the advice and guidance provided.
• The police will always create a duty of care through this process of consultation.

Police use S136 powers following consultation with Mental Health Services

•  Sgt authority to use S136 powers.

Transport required and ambulance called

•  Transport required and ambulance called.
• No ambulance free within 30 minutes.
• FCR supervisor / FIM escalate to ambulance and re-Thrive.
• If still no ETA or outside 30 minutes Sgt authority to use police vehicle. 

 Police arrive at a Mental Health Place of Safety (PoS) for handover 

• Risk assessment cannot be agreed.
• NHS must expressly agree to accept the person.
• If no Mental Health Services staff to do handover with the escalation process to be used after 30 minutes.
• If no agreement on risk assessment the escalation process is to be used.
• If police leave the PoS they must maintain oversight of the detention and ensure the person is being properly dealt with.
• The police log will be kept open and a call made to Mental Health Services every 2 hours to ensure that the person is being properly dealt with. 

Police attend mental health call, no injury, and voluntary patient 

• Police attend mental health call for service (no physical injury)
• Officers at the scene call Mental Health Services for patient to consult.
• Officers to let the person speak directly to Mental Health Services.
• If patient unable to speak to Mental Health Services and police will do so.
• The police will always speak to Mental Health Services as well as the person to ensure correct understanding of the advice and guidance provided.
• The police will always create a duty of care through this process of consultation.

Mental Health Services advise the person should go home 

• Following consultation with Mental Health Services and on their advice the duty of care can be discharged by leaving the person at home, alone if necessary. This follows the principles of Right Care Right Person and ensures the mental health specialists provide expert guidance on the right way to support someone.

Transport required 

• Ambulance will not transport someone to take them home.
• Police vehicle to be used.
• Sgt authority is not required.

Mental Health Services advise the person should go to a PoS (Mental   Health facility, Crisis Café, Safe Space) 

• Transport required. No ambulance free within 30 minutes. No category applies so availability of ambulance dictates
• FCR escalate to ambulance and re-Thrive.
• If still no ETA or outside 30 minutes authority to use police vehicle required.
• Webley handover to be completed with ambulance crew if they attend the scene.
• Webley handover to be completed at PoS if taken by police.
• If the person cannot be left unattended as they may come to harm or harm others prior to the handover the police will remain until a member of staff is available.
• If delays are experienced and the person is considered able to support themselves whilst waiting for support the Webley form to be left with the person. The police will wait a maximum of 30 minutes to handover.
• Staff at the facility to be informed the police are leaving.

Police attend mental health call, physical injury (self-harm), and voluntary patient

• Police attend call for service (physical injury)
• Ambulance to be called to attend
• No ambulance free within 30 minutes. No category applies so availability of ambulance dictates.
• FCR escalate to ambulance and re-Thrive.
• If still no ETA or outside 30 minutes Sgt authority to use police vehicle.
• Webley handover to be completed with ambulance crew if they attend the scene.
• If no ambulance can attend the police will transport the person to the Emergency Department (ED).
• No requirement for police to consult if not considering the use of S136.

Police arrive at the Emergency Department for handover 

• Webley handover to be completed.
• If delays experienced, Webley form to be left with patient.
• The seriousness of any injury will denote the time police will wait to handover the person to nursing staff.
• If the person cannot be left unattended as they may come to harm or harm others prior to the handover the police will remain until a member of staff is available. In cases of serious harm the police will wait for the triage process to take place and complete the Webley handover with nursing staff.
• The police will wait a maximum of 30 minutes to handover for minor cases of self-harm leaving the person in ED.
• Nursing staff to be informed the police are leaving.

Chapter 5 – Further Information and Toolkits

5. Legal Powers

2a – Common Law

It is important to note that in the context of welfare checks Police have no general common law responsibility for ‘safety’ or ‘welfare’ of members of the public. The central principle is that police will respond to requests to carry out a ‘welfare check’ ONLY when they engage the core duties of police:

• To prevent and detect crime
• To keep the Queen’s peace, and
• To protect life and property.

The carrying out of this type of check is simply the discharge of the general duty to investigate crime and perform other core policing functions. It is not an assumption of care for the safety of any particular individual.

2b – Article 2 ECHR (European Convention on Human Rights)

2.1     “Everyone's right to life shall be protected by law. No one shall be deprived of his life intentionally save in the execution of a sentence of a court following his conviction of a crime for which this penalty is provided by law”.

There are two main aims to this convention right – namely

• A prohibition on the state from taking a life and
• A positive duty placed upon the state to protect life

And – Article 3 ECHR:

“No one shall be subjected to torture or to inhuman or degrading treatment or punishment”

Conduct qualifying under Article 3 may include being subjected to serious violence/serious injury, being the victim of sexual offending. 

2c – PACE (Police and Criminal Evidence Act) 1984 – Section 17

 17(1) Subject to the following provisions of this section, and without prejudice to any other enactment, a constable may enter and search any premises for the purpose –

1. e) of saving life or limb or preventing serious damage to property (see notes iv and vi below).
2. iv) Section 17(1)(e) life and limb refers to humans only but animals can be property.
3. vi) See below for the case of R v Syed which is an important case for any officer using the power under section 17(1)(e).

In the case of Syed v DPP [2010] the High Court ruled that this provision did not justify entry where there was a general concern for the welfare of someone within the premises and therefore officers were not in the execution of their duty when purporting to rely on s17 to force entry against the wishes of the person who answered the door.

Mr Collins said:

“It is plain that Parliament intended that the right of entry without any warrant should be limited to cases where there was an apprehension that something serious was otherwise likely to occur, or perhaps had occurred, within the house….Concern for welfare is not sufficient to justify an entry within the terms of section 17(1)(e). It is altogether too low a test.

I appreciate and have some sympathy with the problems that face officers in a situation such as was faced by these officers. In a sense they are damned if they do and damned if they do not, because if in fact something serious had happened, or was about to happen, and they did not do anything about it because they took the view that they had no right of entry, no doubt there would have been a degree of ex post facto criticism. But it is important to bear in mind that Parliament set the threshold at the height indicated by section 17(1)(e) because it is a serious matter for a citizen to have his house entered against his will and by force by police officers.”

*Legal advice in regards to ‘Concern for welfare’ requests and the liability placed on police has already been sought from the following sources

• Sarah Winfield – Director of legal services – NSY ( Appendices)
• Caroline Sellars – East Midlands legal services – Advice to Derbyshire - Oct 2014 (Appendices)
• David Ring – East Midlands Legal Services

2d – Use of Force

 S3 Criminal Law Act

“A person may use such force as is reasonable in the circumstances in the prevention of crime, or in the effecting or assisting in the lawful arrest of offenders or suspected offenders, or of persons unlawfully at large”

Police powers do not extend to physical intervention with persons an officer considers to have mental health issues (MCA 2005 – Officers cannot make this assumption). The exception is under s136, in a public place or police station.

S117 PACE

Power of constable to use reasonable force.

Where any provision of this Act—

(a) confers a power on a constable; and

(b) does not provide that the power may only be exercised with the consent of some person, other than a police officer, the officer may use reasonable force, if necessary, in the exercise of the power.

2e – Mental Health Act – Section 136 

(1)	If a person appears to a constable to be suffering from mental disorder and to be in immediate need of care or control, the constable may, if he thinks it necessary to do so in the interests of that person or for the protection of other persons – Remove the person to a place of safety within the meaning of section 135, or If the person is already in a place of safety within the meaning of that section, keep the person at that place or remove the person to another place of safety.
(1A)	The power of a constable under subsection (1) may be exercised where the mentally disordered person is at any place, other than – Any house, flat or room where that person, or any other person, is living, or Any yard, garden, garage or outhouse that is used in connection with the house, flat or room, other than one that is also used in connection with one or more other houses, flats or rooms.
(1B)	For the purpose of exercising the power under subsection (1), a constable may enter any place where the power may be exercised, if need be by force.
(1C)	Before deciding to remove a person to, or to keep a person at, a place of safety under subsection (1), the constable must, if it is practicable to do so, consult – A registered medical practitioner A registered nurse An approved mental health professional or A person of a description specified in regulations made by the Secretary of State.
(2)	A person removed to, or kept at, a place of safety under this section may be detained there for a period not exceeding the permitted period of detention for the purpose of enabling him to be examined by a registered medical practitioner and to be interviewed by an approved mental health professional and of making any necessary arrangements for his treatment or care.
(2A)	In subsection (2), “the permitted period of detention” means – a)     The period of 24 hours beginning with - i.          In a case where the person is removed to a place of safety, the time when the person arrives at that place; ii.          In a case where a person is kept at a place of safety, the time when the constable decides to keep the person at that place, or b)    Where an authorisation is given in relation to the person under section 136B, that period of 24 hours and such further period as is specified in the authorisation.
(3)	A constable, an approved mental health professional or a person authorised by either of them for the purposes of this subsection may, before the end of the permitted period of detention mentioned in subsection (2) above, take a person detained in a place of safety under that subsection to one or more other places of safety.
(4)	A person taken to a place of safety under subsection (3) above may be detained there for the purpose mentioned in subsection (2) above for a period ending no later than the end of the permitted period of detention mentioned in that subsection.
(5)	This section is subject to section 136A which makes provision about the removal and taking of persons to a police station, and the keeping of persons at a police station, although this practice is not supported by Humberside Police and no one will be placed in cells when under a S136.

6. THRIVE T.H.R.I.V.E. (INCIDENTS)

Definition of Vulnerability:
 

“A person is Vulnerable if, as a result of their situation or circumstances, they are unable to take care of or protect themselves or others from harm or exploitation”

For Emergency (E); High (H) and Prompt (P) grade logs; the Contact Officer should add a statement to the effect that the Log has been sent to Dispatch for deployment; DRT Slow Time for DA Prompts or DSL for other Prompt grade log checks. The log must contain sufficient information to enable colleagues to add a meaningful THRIVE explanation.

For Hub grade logs, a THRIVE level & a THRIVE explanation must be added to each Log.

The THRIVE process should be simple and fast whilst remaining effective and meaningful.

It should not be onerous, time consuming or meaningless in its application. 

1)   T H R I V E     (Threat Harm Risk Investigation Vulnerability Engagement) 

Taken as a whole, the  T H R I V E  level (measured as Low, Medium or High), is determined by considering the Harm & the Risk associated with an incident (which gives you the Threat level).

Then you consider the Vulnerability factors associated with that incident (examples of Vulnerability are shown in the Table below).

Remember – with ‘Threat’ we are talking about a risk assessment of the likelihood of something happening or getting worse – rather than an actual verbal or physical threat towards someone.  

• Harm:

- Who or what has been harmed? Physical? Emotional? Property? Financial?

- Could it affect the Community or could it affect the reputation of the Police?

• Risk:

- Has it already happened? Could it happen? Get worse? Happen elsewhere?

(III) Investigation:

- Other than the information obtained from the caller using 5WH and open questioning, what further information has the caller provided?

(IV) Vulnerability:

- Before you can Grade the incident and assign a T H R I V E level to the record you have created, you must establish, through open questioning, any Vulnerabilities & Safeguarding issues.

(V)  Engagement:

- First of all, consider the question “Is this a police matter?”

If ‘NO’ then signpost to another agency or deal with the matter yourself (advice only; log/contact record & close).

If ‘YES’ (and not a quick call taker self-resolution) then Engagement = log to DRT (Fast or Slow) or CRT control areas.

- What are the Callers’ Expectations? (Attendance / Call Back / Advice Only / NFA)
- What have you advised the caller will / may happen next?
- If unsure or no expectation given – record reason on Contact Record / Log.
- Record all the above on the Contact Record/Log.

Vulnerability can take many forms so you must consider all possibilities.

The below is a guide and a starting point but it is not an exhaustive list:

 

VULNERABILITY FACTORS
6. THRIVE
Health and Disability	Economic Circumstances	Learning Disabilities
Deprivation	Physical Disability	Illness
Mental Health Needs	Drug / Alcohol Misuse	Homelessness
Financial Concerns	Poor Housing Conditions (including Location)
PERSONAL CIRCUMSTANCES
Consider Themselves Vulnerable	Social Isolation	Poor Social Skills
History of Offending	Self-neglect	Overcrowding
Affected by ASB
FAMILY CIRCUMSTANCES
Child Protection	Child in Need	Child in Care
Domestic Abuse	Family Members / Carers with Mental Health Needs / Drug / Alcohol Problems
EQUALITIES / DISCRIMINATION
Gender Identity / Transgender	Sexual Orientation	Ethnic Background
Language Barrier	Age	Disability

 

7. Governance and Decision making structure

The force seeks to promote professional decision making based on a rationale and modelled approach (NDM – National Decision Making Model). Decision making is supported by Policy, Guidance, Experience and Leadership.

All those working within the force, from the Chief Constable to all levels of Officer (Staff or Police) should be open to challenge and where they think a decision is flawed they should challenge (appropriately).

Call Taker

When a call is received into the FCR the first decision made is that by the Call Taker. They are trained, have experience and employ a rationale decision making tool – THRIVE. This supports their decision making and ensures that calls that are non-police issues are dealt with appropriately. 

Controller

The controller will receive the details of an incident from the call taker that will include an assessment in respect of response (Schedule, Priority or Urgent) based on THRIVE. It is correct that the controller should assume the detail on the log correct. The controller should then consider the decision and before dispatching a resource ensure the incident is appropriate and the deployment grade suitable. Controllers should always review an incident and be prepared to change it as necessary (again based on a rationale).

Controllers tend to be experienced police staff that have a greater understanding of the role of policing and current demand. 

Supervisor

Controllers, if in doubt should share the decision making with their Supervisor, the Centre Manager or Duty Inspector (the Duty Inspector will always have the final decision in the case where agreement cannot be reached).

It is recognised that our most junior staff are those that make the initial decision. Therefore it is right and proper that that initial decision is scrutinised and challenged to ensure we resource incidents appropriately.

Staff should remember sending police officers to issues in which they have no powers; little training or understanding (i.e. Mental Health) creates a significant risk for the officer, the individual concerned, the call-taker and controller as well as the organisation. The presumption that to deploy if in doubt as a positive act is flawed. We should always seek to send the most appropriate resource