Police custody healthcare: The case for the AAAQ framework

Area of Science:

• Public Health
• Healthcare Management
• Criminology

Background:

• Police custody suites provide essential healthcare services to detained individuals.
• The quality and accessibility of healthcare in these settings are critical for detainee welfare and public health.
• Existing healthcare delivery models face scrutiny regarding their adherence to established quality frameworks.

Purpose of the Study:

• To evaluate healthcare delivery in English and Welsh police custody suites using the Available, Accessible, Acceptable and Good Quality (AAAQ) Framework.
• To identify systemic deficiencies in healthcare provision within police detention settings.
• To propose recommendations for improving healthcare standards and oversight.

Main Methods:

• A mixed-methods approach combining ethnography of custody suites, semi-structured interviews with professionals and persons with lived experience, and documentary analysis of risk assessments and case logs.
• Investigated two English police forces, involving four custody suites.
• Collaborative qualitative thematic analysis was conducted by the research team and peer analysts.

Main Results:

• Police custody healthcare frequently fails to meet AAAQ standards, lacking availability at the point of need due to insufficient embedded professionals.
• Healthcare is not universally acceptable or accessible, hindered by stigmatised assumptions and scepticism towards detainees' medication requests.
• Variable treatment provision ('Postcode Lottery') due to differing private provider directives impacts Good Quality healthcare; insufficient resourcing is the primary cause.

Conclusions:

• The AAAQ Framework offers essential standards for evaluating healthcare in police custody suites.
• Current healthcare provision in police custody is inadequate, requiring significant improvements in availability, accessibility, acceptability, and quality.
• Recommends commissioning police custody healthcare under NHS England Health and Justice for improved oversight and governance, with potential application of the AAAQ framework to other carceral healthcare settings.