In the custody cell, safeguarding and health care

Indicators (what we expect to see)

• All cells are equipped with working call bell systems that cannot be permanently muted. Staff explain to detainees how to use the call bell and activations are responded to promptly.
• Cells and communal areas are clean, free from ligature points and graffiti, of a suitable temperature and well ventilated. Staff carry out daily cell checks to maintain these standards and records are maintained and monitored.
• There are adequate arrangements in place for daily cleaning, removing any biological hazards, regular deep cleaning, and prompt repair of any defects. 
• There is written guidance, which is followed, on the use of cells with restricted natural light and facilities.
• Staff can safely evacuate the custody area in the event of an emergency and evacuations are regularly practiced and recorded.
• All equipment (including the resuscitation kit) is appropriate, ready for use and regularly checked and maintained (cross reference with governance of health care).
• All staff understand how to access and use the emergency equipment effectively (cross reference with governance of health care).

Indicators (what we expect to see)

• All staff are trained in and use effective de-escalation techniques.
• Where force is used, staff only use approved techniques in line with their training, with no more force and for no longer than is strictly necessary and proportionate.
• Staff can demonstrate awareness of risks associated with particular forms of restraint and of how these risks can be minimised. When force is used detainees are examined by an appropriately qualified health care professional if requested, or if there are health care concerns.
• Use of force prior to arrival and within custody suites, including the use of control and restraint equipment, is documented within the individual custody record and a separate ‘use of force’ form is submitted.
• Conductive Energy Devices and incapacitant sprays should be used in exceptional circumstances only. When used detainees are examined by an appropriately qualified health care professional if requested, or if there are health care concerns.
• Detainees in need of mental health care who are restrained for their own or others’ safety are treated as a medical emergency. Custody officers and staff have easy access to mental health guidance and a mental health practitioner.
• Strip-searching is conducted only when absolutely necessary, is appropriately authorised, is carried out in private by members of staff of the same gender, in the presence of an appropriate adult if required, and is monitored at a senior level to ensure appropriate use. If a detainee is strip-searched it is recorded.

Indicators (what we expect to see)

• Detainees are offered sufficient food and drink and if in extended detention there is a varied diet.
• Detainees are able to be clean and comfortable, and alternative clothing is available while in custody.
• Women detainees are provided with suitable sanitary products as necessary.
• Detainees are offered exercise, suitable reading materials and/or activities. Children and other vulnerable detainees are provided with the opportunity to have visits by family members and/or appropriate agencies that can provide support.
• Custody staff are aware of the impact of isolation for those detained over several days – and take suitable steps to mitigate associated risks, especially for those detainees identified as vulnerable.

Indicators (what we expect to see)

• Staff are trained in safeguarding and have the knowledge required to identify and protect vulnerable groups in their care, including arrangements for contacting appropriate adults and making appropriate referrals to partner agencies.
• Current government and local guidance about safeguarding children and vulnerable adults is accessible and safeguarding procedures are known and used by all staff.
• Persons responsible for the welfare of detained children are informed of the child’s detention (and the grounds, where appropriate, for their being detained) at the earliest opportunity.

Indicators (what we expect to see)

• The Force works actively with local partners to ensure provision of independent, effective, and suitably vetted appropriate adults for vulnerable adults and children where the parent or guardian is unwilling, unable or unsuitable to act.
• For those under 18, parents or guardians are used whenever they are willing, able and suitable for the appropriate adult role. They are given guidance in writing on the role and are encouraged to be active in protecting the child’s rights.
• There are no delays in securing an appropriate adult and they are available 24 hours a day.
• Adequate facilities are available to ensure that appropriate adults are able to speak to vulnerable adults or children in private and to sit with them if the appropriate adult considers that this is necessary to ensure their welfare.
• The Force collects data in relation to the provision of appropriate adults, including those who performed the role (for example parents/guardians, youth offending teams and social workers). The data should include waiting times and which aspects of the process they were present for, and should be collated and analysed to assess whether the service is meeting the needs of children and vulnerable adults.
• Staff receive regular safeguarding training and know how to implement the agreed safeguarding procedures.
• Any child suspected of committing a criminal offence is treated under the safeguarding procedures and appropriate authorities are notified immediately.

Indicators (what we expect to see)

• When force is used children are always examined promptly by an appropriately qualified health care professional.
• Staff understand and respond to the distinct needs of children, recognising levels of maturity and how physical, sexual and emotional abuse and exploitation might affect a child’s behaviour and any subsequent decisions taken about their care and welfare.
• Custody officers and staff are alert to the signs that a child may have been a victim of child sexual exploitation, trafficking or grooming for terrorism, know how to report it and do so appropriately.
• Risk assessments are based on all relevant information. Particular attention is given to recognised risks associated with:
  • looked after children
  • disabilities, including intellectual impairment (learning disabilities), communication difficulties, health conditions and substance misuse
  • a previous history of abuse
  • those in custody for the first time.

Indicators (what we expect to see)

• Children are kept separate from those who might pose a risk to them. Where it is safe to do so, children are not held in cells.
• Children are returned home to their parent/guardian. Where this is not possible and/or there are safeguarding concerns, there are effective arrangements with the local authority that cover the provision of accessible, safe accommodation for children.
• Children are kept safe in custody.
• Female detainees under the age of 18 are allocated and informed of the identity of a named female officer who is responsible for meeting their welfare needs while detained.
• Only age-appropriate approved restraint techniques are used for children. Pain compliance techniques are never used on children.
• No child is subjected to a strip-search unless it is intelligence-led, authorised by an officer of superintendent rank and conducted in the presence of an appropriate adult. The search is recorded.

Indicators (what we expect to see)

• The requirement for health services for detainees in TACT suites is assessed and the services provided are appropriate to need.
• Clinical governance arrangements are robust and effective, including partnership working between the force and health providers, incident management, information sharing, a confidential health complaints process and processes to improve provision based on lessons learned.
• Patients are seen promptly by competent health staff who receive regular relevant training, supervision and support.
• Patients are treated with dignity, respect and compassion.
• Clinical examinations are conducted confidentially unless risk assessment suggests otherwise.
• Clinical facilities, including rooms where forensic samples are taken, are fit for purpose and meet required infection prevention and control standards.
• Patients are kept safe and are safeguarded from abuse.

Indicators (what we expect to see)

• All detainees who are held in TACT detention are seen promptly by a health professional including on arrival, daily and prior to release.
• Arrangements to gain and review patient consent are appropriate. When patients lack mental capacity to make a decision, health professionals make ‘best interests’ decisions in accordance with legislation.
• Interventions are appropriate to the clinical needs of the detainee and are in line with national guidance.
• Detainees can see a health care practitioner of the gender of their choice on request. There are arrangements for a chaperone to be present if required.
• Professional language interpretation and translation services are used as required.
• Health professionals monitor patients for adverse effects on health and well-being linked to prolonged detention, and implement appropriate plans of care to counteract this.
• Each patient has a single clinical record which meets contemporaneous record-keeping and storage standards.
• Information is shared within the bounds of medical confidentiality to promote continuity of care and maintain patient safety.
• Health care professionals liaise with other agencies and services, as necessary, to ensure all health and substance misuse needs are met and that there is continuity of care during detention and on release.

Indicators (what we expect to see)

• Patients are prescribed and receive required medication promptly.
• Detainees who smoke have prompt access to nicotine replacement treatment.
• Medications are administered at clinically appropriate times by competent staff, and appropriate records made.
• All medications (including detainees’ own) are stored safely and securely, and are disposed of safely if not consumed. There is safe pharmaceutical stock management and use.
• Patients going to court or being released receive adequate supplies of medication or a community prescription to meet their needs.

Indicators (what we expect to see)

• Custody officers and staff receive regular training on mental health and learning disability issues, to help them identify and support detainees who have related needs.
• All staff involved in the care of detainees, including health professionals, are cognisant of the potential adverse impact of prolonged detention on mental health and well-being and take appropriate action to mitigate this.
• There is a clear mental health referral pathway that ensures prompt assessment, appropriate support and continuity of care during detention and on release.
• Patients who require assessment or treatment under the Mental Health Act are assessed and transferred promptly.