Police custody healthcare: The case for the AAAQ framework

ObjectivesTo apply the AAAQ (Available, Accessible, Acceptable and Good Quality) Framework for healthcare as an analytical lens for healthcare delivery in police custody suites in England and Wales.MethodsWe investigated two English police forces via three discrete work packages: an ethnography of four custody suites (two custody suites per police force); semi-structured interviews with professionals (Healthcare Professionals, Police Custody Sergeants and Detention Officers) and persons with Lived Experience of police custody detention (33 professional and 41 Lived Experience interviews); and documentary analysis of 3,200 police custody risk assessments (1,600 per force) and 40 case logs (20 per force). Collaborative qualitative thematic analysis was performed by the research team, but also included peer analysts from a Third Sector organisation.ResultsWe identified that police custody healthcare in its current form does not meet many of the standards of the AAAQ Framework. Healthcare in police custody is not Available at the point of need due to a lack of embedded healthcare professionals; it is not Acceptable nor Accessible to all due to stigmatised assumptions about detained persons and scepticism about their reasons for requesting medication; and it is not Good Quality due to private providers having different Patient Group Directives resulting in a "Postcode Lottery" of treatments based on location of arrest. Insufficient resourcing of healthcare by private providers is the primary cause for these lapses, so we recommend police custody healthcare fall under the commissioning of NHS England Health and Justice to provide some oversight and governance for this domain.ConclusionsThe AAAQ Framework provides a basic set of healthcare standards that should be met in police custody suites. Beyond custody, as traditional forms of healthcare become increasingly carceral (especially maternity services), the AAAQ could also be fruitfully employed in other areas of healthcare nationally and internationally.