title: Provision of forensic medical services to police custody suites in England and Wales: current practice.
abstract: BACKGROUND
  Police services within England and Wales are required under the Police and Criminal Evidence Act 1984 to ensure appropriate healthcare to those detained in police custody (forensic medical services). Traditionally doctors have been used by police services to provide an appropriate level of care. Changes within the Act allowed other healthcare professionals (nurses and paramedics and emergency care practitioners) to be included in the provision of such services. The aim of this appears at least in part to have been to reduce the costs of providing such a service. In recent years police services within England and Wales have been outsourced to assorted commercial providers. There are now several different modes of delivery of forensic medical services, which are determined locally by separate police services.
  
  
  OBJECTIVE
  This study aimed (a) to determine the different modes of delivery of forensic medical services in England and Wales; (b) to determine the healthcare workload caused by Police and Criminal Evidence Act 1984 Codes of Practice; (c) to determine the relative costs of different service models and (d) to determine availability of such information from the police services.
  
  
  METHODS
  The study was undertaken in two parts--(a) a telephone survey of all police services, and (b) an application to each police service utilising the Freedom of Information Act 2000.
  
  
  RESULTS
  All police services (n=43) in England and Wales were contacted. Of the 41 forces that furnished detailed information; 13/41 had a doctor only service; 20/41 had a doctor/nurse service; 6/41 had a doctor/nurse/paramedic service; 1/41 had a doctor/emergency care practitioner service (who may be nurses or paramedic); 1/41 had a doctor/paramedic service. 23/43 services were outsourced to private commercial providers. Mean cost per patient contact (in 17/43 services which supplied data) was GBP 97.25. The cheapest cost per patient contact was the Metropolitan Police Service - a doctor only service (GBP 56.4), the highest Lincolnshire--a doctor only service (GBP 151.1). Mean cost for a doctor only service was GBP 97.1; for a doctor/nurse service--GBP 91.56 and for a doctor/nurse/paramedic service--GBP 115.76. There was no significant difference in costs per patient contact between a doctor only versus mixed HCP delivery of service. Relative costs and 95% confidence intervals expressed as a percentage show that a doctor only model was on average 3.4% lower than a mixed HCP provision, and that a non-outsourced service was on average 9.9% less than an outsourced service. No outsourced service in this study uses a doctor only model.
  
  
  CONCLUSIONS
  The study shows that there was a complete lack of consistency in the recording and availability of information regarding forensic medical services for police services in England and Wales. The information that was obtained suggested that usage of such services varied greatly between police services and that costs of forensic medical services appear to be increased by the use of mixed healthcare professional service delivery and by using external commercial providers.
authors.affiliation: Cameron Forensic Medical Sciences, Clinical Pharmacology, Barts and The London, School of Medicine and Dentistry, University of London, United Kingdom. jasonpaynejames@aol.com
authors.forename: J J
authors.initials: JJ
authors.lastname: Payne-James
authors.forename: W R
authors.initials: WR
authors.lastname: Anderson
authors.forename: P G
authors.initials: PG
authors.lastname: Green
authors.forename: A
authors.initials: A
authors.lastname: Johnston