In the custody accommodation, safeguarding and health care

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Custody accommodation and communal areas are clean, free from potential ligature points and graffiti, of a suitable temperature and well ventilated, with access to natural light. Staff carry out daily checks and records are maintained and monitored.
• All custody accommodation is equipped with working emergency call bell systems that cannot be permanently muted. Staff explain to detainees how to use the call bell and activations are responded to promptly.
• There are working fire alarms throughout the custody area and staff can safely evacuate the custody area in the event of an emergency. Evacuations are regularly practised and recorded.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• 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.
• Staff demonstrate awareness of risks associated with particular forms of restraint and how these risks can be minimised.
• When force is used, detainees are examined afterwards by an appropriately qualified health care professional.
• Detainees in need of mental health care who are restrained for their own or others’ safety are treated as a medical emergency.
• All staff involved in the use of force against a detainee complete individual use of force statements promptly, which clearly explain what happened and why force was used.
• Use of force documentation and associated CCTV footage is retained appropriately. It is subject to robust quality assurance to make sure any force used is necessary and proportionate, and to identify and address any learning.
• Detainees are only subject to proportionate searching which is sensitively and properly conducted.
• Strip-searching is appropriately authorised and a written record is maintained. It is monitored at a senior level to ensure appropriate use. Searches are carried out in private by staff members of the same sex as the detainee (in the presence of an appropriate adult if required).

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Detainees are offered sufficient and varied nutritious food and drink in accordance with their dietary, cultural and religious requirements.
• Detainees can shower every day and suitable clean clothing, including underwear, is available to them.
• Detainees are provided with a clean mattress, pillow and blankets or duvet.
• Detainees can use the toilet with respect for their privacy. Toilet paper and handwashing facilities are readily available.
• Detainees have daily opportunities to participate in activities that benefit them and improve their well-being, including access to reading and writing materials.
• Detainees are offered daily outside exercise.
• Detainees, particularly children and other vulnerable detainees, are given the opportunity for visits by family members and/or appropriate agencies that can provide support.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Custody staff are trained in safeguarding and have the knowledge required to protect vulnerable groups in their care, including arrangements for contacting appropriate adults and making suitable referrals to partner agencies.
• Current government and local guidance about safeguarding children and adults is accessible, and safeguarding procedures are known and used by all staff.
• There are no delays in securing an appropriate adult and they are available 24 hours a day.
• There are facilities for appropriate adults to speak to children and vulnerable adults in private and to remain with them if the appropriate adult considers this is necessary to ensure their welfare.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Parents/guardians are informed of a child’s detention in custody and the grounds for detention at the earliest opportunity, unless it is not in the best interests of the child.
• Children are kept safe in custody and separate from those who might pose a risk to them. Where it is appropriate to do so, children are held in accommodation other than cells.
• Staff understand and respond to the distinct needs of children, recognising levels of maturity.
• Girls are cared for by a named female officer who is responsible for meeting their welfare needs while detained.
• Only age-appropriate and approved restraint techniques are used on children. When force is used, children are always examined promptly by an appropriately qualified health care professional.
• No child is subjected to a strip search unless it is intelligence-led, authorised by a senior officer and conducted in the presence of an appropriate adult.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• The requirement for health services for detainees in service custody facilities is assessed and the services provided are appropriate for the need.
• Clinical governance arrangements include robust incident management, a confidential complaints process, monitoring of response times for all health services and monitoring of patient outcomes, with processes established to learn lessons from complaints and incidents.
• Detainees are treated promptly by health care practitioners who have the skills, knowledge and competencies to meet their health care needs.
• Health care practitioners are sensitive to detainees’ situations and diverse needs and treat them with respect and compassion.
• Information sharing protocols exist with appropriate agencies to ensure efficient and confidential sharing of relevant health and social care information.
• Clinical consultations are conducted confidentially unless a risk assessment suggests otherwise.
• Clinical rooms are fit for purpose and comply with current infection control standards.
• Detainees can see a health care practitioner of the sex of their choice on request. There are arrangements for a chaperone to be present if required.
• Staff are first aid-trained and have access to first aid and suitable resuscitation equipment that is regularly checked, maintained, and ready to use.
• A written protocol is in place for obtaining emergency health care services and all staff know what to do in a health emergency.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• All detainees are seen promptly by a health care practitioner, including on arrival and before release.
• Arrangements to gain and review patient consent are appropriate. When patients lack mental capacity to decide, health care practitioners make ‘best interests’ decisions in accordance with legislation.
• Treatments are appropriate to the clinical needs of the detainee and are in line with national guidance.
• Detainees receive health services that are not restricted by security or regimental procedures.
• Each detainee has a single clinical record containing an up-to-date assessment, and any care plan conforms to national guidance.
• The use and storage of clinical records complies with good practice.
• The results of any clinical examination are made available to the detainee and, with the detainee’s consent, his or her legal representative.
• Health care practitioners liaise with other agencies, as necessary, to ensure continuity of care.
• Detainees carry out work or training only after they have been examined by a health care practitioner and certified as fit to undertake it.
• Any detainee held in cellular confinement, or subject to any form of mechanical or physical restraint, is seen at the point of restraint or confinement or as soon as possible thereafter. Detainees subject to such controls are seen by a health care practitioner at least once every day.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Detainees are prescribed, or have access to, existing medication to treat any clinical signs, symptoms or existing medical conditions.
• Detainees receive medication to provide relief for drug and alcohol withdrawal symptoms if clinically indicated and can continue community prescribed opiate substitution treatment in custody, subject to validation.
• Medication is administered at clinically appropriate times by competent staff, and appropriate records made.
• All medication on site is stored safely and securely and is disposed of safely if not consumed. There is safe pharmaceutical stock management and use in custody.
• Patients being released receive adequate supplies of medication or a community prescription to meet their needs.

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• An effective service is provided to detainees with drug and alcohol problems.
• Detainees can access specialist substance misuse services to ensure an appropriate range of care support.
• Any contact with a drug or alcohol worker is recorded in the custody record.
• Where appropriate, detainees are provided with harm minimisation supplies and advice on release, such as the provision of clean needles and a supply of naloxone (an opiate overdose antagonist).

The following indicators describe evidence that may show this expectation being met, but do not exclude other ways of achieving it.

• Custody staff and health care practitioners receive regular training on mental health and learning disability issues, to help them identify and support detainees who have related needs.
• Anyone detained who is identified as having mental health concerns is immediately considered for diversion away from custody to enable an assessment of their condition.
• Local arrangements with the relevant Defence Medical Services support access to a clear mental health referral pathway. This ensures detainees are promptly assessed, given appropriate support and provided with continuity of care during detention and on release, particularly where detainees are believed to be experiencing severe and acute mental health issues after arrival in custody.
• Health care practitioners signpost detainees to and liaise with other relevant agencies to ensure continuity of care, including community mental health services if required.
• Patients who require assessment or treatment under the Mental Health Act are assessed and transferred promptly.