Recommendation - Greater Manchester Police, September 2020

The IOPC recommends that the College of Policing amend the custody and detention, detainee care section of the Authorised Professional Practice (APP) to make it clear what they expect officers to do when a detainee cannot be roused in accordance with the rousing procedure (set out in Annex H of PACE Code C). ​

This follows a case where there was a near-miss in custody. A detainee, who was believed to be intoxicated, was placed on level two observations, with a requirement to be roused every 15 minutes. When the detainee was later checked he could not be roused. A Health Care Professional (HCP) was called who assessed the detainee but an ambulance was not called. When the detainee was next checked, they again could not be roused and an ambulance was called. The detainee was taken to hospital where they later recovered.

Annex H of PACE Code C states that “Officers must call an appropriate HCP or an ambulance if a detainee cannot be roused...”

The APP on detention and custody states “Police forces should adopt procedures to ensure that custody officers and staff adhere to the rousing procedures outlined in Annex H of PACE Code C.” This is also repeated in the section on alcohol and drugs.

However, the APP also states: “Rousing involves the use of a stimulus designed to elicit a response from the detainee. Only when the detainee has given a comprehensive verbal response can they be considered as adequately roused. If a detainee cannot be roused, they should immediately be treated as a medical emergency.”

Earlier in this section of the APP, under Medical Emergency, it states: “In medical emergencies, officers should call an ambulance immediately to convey the detainee to hospital as soon as possible. If an appropriate HCP is available at the police station, they should be asked to attend the detainee while awaiting the ambulance.”

It therefore appears there are conflicting or inconsistent obligations set out in the APP, specifically:

whether or not this situation should be treated as a medical emergency which means officers should call an ambulance immediately; orwhether officers have the discretion to either call a Health Care Professional or an ambulance (as per PACE).

Do you accept the recommendation?

Yes

Accepted action:

For ease of reference, you have recommended that the College ‘…amend the custody and detention, detainee care section of the Authorised Professional Practice (APP) to make it clear what (we) expect officers to do when a detainee cannot be roused in accordance with the rousing procedure (set out in Annex H of PACE Code C)’.

We have now reviewed APP and Annex H of PACE Code C and can confirm we will make the following adjustment to APP. Our rationale is explained below.

Under ‘Rousing’ in APP we will remove:

‘Officers must call an appropriate HCP or an ambulance if a detainee cannot be roused in accordance with the above criteria.’

We will replace this with:

‘PACE Code C Annex H requires that ‘If any detainee fails to meet any of the … criteria (which is listed above this statement and is taken directly from the Code), an appropriate healthcare professional or an ambulance must be called’. This is the law. However, the College recommends a more cautious approach. The College advice is to treat the incident as a medical emergency and call an ambulance if a person cannot be roused.

If an appropriate HCP is available at the police station, they should also be asked to attend the detainee while waiting for the ambulance.’

Our rationale is based on the fact that PACE allows for either the calling of an ambulance or HCP in the scenario where a detainee cannot be roused. In this sense APP is quoting the law and is not inconsistent, we are merely recommending a more risk adverse approach above
what is required by law. Following your feedback we felt it was important to explain this distinction, whilst taking on board your concerns about relying solely on PACE. However without a change to the Code itself it can be argued that adherence to the Code is an acceptable course of conduct because the Code is secondary legislation and takes primacy over APP.