A new Preventing Future Deaths report was published this week after the inquest in Hull after the death of Mr Peter Ramsden. It raises “Right Care, Right Person” again, this time with power of entry discussions for welfare checks. Mr Ramsden died at his home address at some point in the two months prior to being found. Someone concerned they hadn’t seen them for that long rang the emergency services to say so and paramedics were dispatched to the address. Having no power to enter premises, they left after receiving no reply at the door and some while later entry was gained and Mr Ramsden found.
The Preventing Future Deaths report is just a touch too vague to answer all the questions I immediately had, such as who eventually entered and found Mr Ramsden and it raises questions about all three emergency services and their arrangements for forcing entry in respect of welfare checks which might have answers in the real world – they’re just not discernible to us from reading it. But regardless of that, there are things within this PFD which offer useful insights and even the unanswerable questions generated by it are important to think about for other areas, even if they do have answers in Humberside.
LACUNA IN THE LAW
Professor Marks, HM Coroner, is concerned with a “lacuna” and has directed his PFD notice to the Home Office, not to any of the individual agencies who are copied in to it but not obliged to reply. His “matter of concern” is that section 17 of the Police and Criminal Evidence Act 1984 allows the police to force entry to save life and limb (and certain other things) but paramedics have no power of entry. He states –
“Due to the Right Care, Right Person model the police did not get involved, as it was thought by the concerned individual that this is man not being seen was due to a medical problem.”
I’m ultimately unclear whether this means the police were contacted – “did not get involved” suggests to me they were asked and declined but I’d be happy to learn otherwise, hence my more general complaint that PFD prevents us understanding what has gone on here.
This next bit is key –
“Evidence was heard which suggested that on occasions, the ambulance service and the fire service should have powers of entry in the event that a persona who is ill, unconscious or otherwise incapacitated, with a remediable disorder, can received prompt and potentially life-saving treatment … situations could and will arise where time-sensitive pathological processes require emergency treatment to save life.”
Prescriptive / descriptive – what should be true and what is true are often different things and somewhat obviously, incidents are managed by reference to the law as it is – not the law as it should be, according to some. We all have opinions.
So my main concern after reading this PFD is to wonder why those questions aren’t settled, given RCRP began in this police force area around five years ago – only being rolled out nationally, later on.
FIRE SERVICE ENTRY
The discussion about powers for the fire service is interesting – for years and years, I kept hearing about the right of firefighters to force entry to premises and of course, they can. They do so to burning buildings to either rescue people or put out fires and they could do so for other reasons, set out in s11 of the Fire and Rescue Services Act 2004 (FRSA). Many discussions on this tend to focus on s44 FRSA but you can see in another post on this blog why that’s not correct.
Suffice to say here that s11 states –
11 Power to respond to other eventualities
(1) A fire and rescue authority may take any action it considers appropriate—
(a) in response to an event or situation of a kind mentioned in subsection (2);
(b) for the purpose of enabling action to be taken in response to such an event or situation.
(2) The event or situation is one that causes or is likely to cause—
(a) one or more individuals to die, be injured or become ill;
(b) harm to the environment (including the life and health of plants and animals).
So there you go: obvious potential to have some kind of conversation about what role the Fire Service could play in forcing entry to premises to enable the ambulance service to access the scene and / or treat someone. But at least one fire service I know of has said they’re “too busy” to take on this role in support of one agency, where another has a duty to act …
Therefore, given the number of situations in which this discussion may arise, I’m interested in whether there is a multi-agency protocol in the area which covers all of this, across the wide totality of situations. The Coroner wrote “evidence was heard which suggested that on occasions, the ambulance service and the fire service should have powers of entry” – I’m confused by the word “should” and what it means for the understanding which is needed to ground any discussion about what should be happening and who should be doing it.
A MEDICAL MATTER?
I found the use of the term “medical problem” rather disconcerting – the Coroner used that term in respect of the concerned person who rang as if to imply they deliberately didn’t involve the police because of their perception it was a medical issue. Perhaps that’s correct – I can’t know otherwise. We don’t know from the PFD whether the police service was contacted at all and if so what they said; we don’t even know which agency the concerned person rang.
But in RCRP terms, that debate seems a little fallacious – the published threshold for police intervention includes “an immediate risk to life” or “risk of serious harm”. Those thresholds can be present for situations which are entirely medical matters to which the police would respond – and we know they often do. Indeed the reassurance given by senior police officers when RCRP was making national headlines was to emphasise the police were not refusing to attend and would always be there if there was an “immediate risk to life” and we need to remember: such a duty is owed by the state as a whole, not by individual agencies and all organisations are bound by section 6 of the Human Rights Act 1998.
My own experience whilst still serving is that training on the “immediate risk to life” threshold is not correct, it’s overly narrow and that several other PFDs prior to this one for Mr Ramsden demonstrate an overly narrow approach to what this legal concept means. Importantly for the debate about which agency should be responding and how that decision is made, is that it takes time to bounce 999 calls between agencies and incurs delay, even if relatively briefly.
JOINT PROTOCOLS
A few PFDs which highlight Right Care, Right Person raise the question of agreements across agencies about how things will work. In the Heather Findlay inquest, the Metropolitan Police informed a London coroner they were introducing RCRP and changing their response to AWOL patients who go missing from psychiatric units – but they admitted in evidence they hadn’t had discussion with the relevant mental health trust who were still under the impression the police would respond. Even the Coroner in that PFD ended up wondering how that could work if the trust weren’t aware the police were changing tack.
In this case there’s no doubt partners knew of RCRP changes because Humberside went about a year or more of pre-programme, awareness-raising partnership work but I ended up wondering how well-established the dynamics are for ensuring entry to premises where entry should be gained?
Debate all day long if you want about whether that should have been police or fire who should have forced entry, but what seems obvious from the context is that someone should have done and whilst some kind of debate goes on about ambulance service powers of entry, the real world is that one of the other two emergency services needed to do so and it didn’t happen until an unspecified amount of time later.
PARAMEDICS VIEWPOINTS
Final question: has anyone asked the ambulance service whether it wants paramedics to have these powers, given the discussion needs to take account of a wide variety of circumstances, broader than an elderly man who hasn’t been seen for a concerning amount of time.
So even if the Home Office respond to this PFD by immediately putting forward legislation to create powers of entry (unlikely) and even if the entire paramedic profession agree they want responsibility for forcing doors off people’s premises (unlikely), areas would still need joint protocols for who does what and when. Some situations of forced entry are going to require the police because of opposition to entry that no paramedic or firefighter is going to take on – and nor should they. You’ll still need a joint protocol about this, for the avoidance of doubt and prevention of delay.
UPDATE: Information now known to me, since writing this piece and before it was published, I’m more convinced than before this was an incident which likely required a police response.
Awarded the President’s Medal, by the Royal College of Psychiatrists.
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(c) Michael Brown, 2025
I am not a police officer.
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