I recently had a clear-out of unpublished posts, most of which were just incomplete ideas and many of them rendered irrelevant by the passage of time. This one, however, was a complete post which I simply forgot to publish.
It’s all phrased as if the events within are recent, just bear in mind it relates to 2023! – published because the issues are still relevant, even if they’re not recent.
The Chair of the Association of Ambulance Chief Executives (AACE), Daren Mochrie has written an open letter to Steve Brine MP, Chair of the Health and Social Care Select Committee, about the Right Care, Right Person initiative (RCRP).
For those very interested in this area of business, it is worth reading the whole letter (it’s only five pages) but I doubt you can avoid the same headline conclusions as the Independent’s health correspondent Rebecca Thomas, who noted claims of a “high stakes game of chicken” and a paragraph emphasising AACE’s view that some police forces have declined to attend incidents where the ‘RCRP Threshold’ would appear to have been met, only for harm to be caused to patients or paramedics.
We heard two weeks ago from the London Ambulance Service when they gave evidence on RCRP to the London Assembly’s Police and Crime Committee that many of the calls being transferred from the police to the ambulance service were indeed patients who required a healthcare response, not a police response. Of course, whether that healthcare response needs to be an ambulance is another debate altogether. Perhaps, though, that debate needs to be had within the NHS? If the London Ambulance Service is accepting most of the people bounced to them by the police are patients requiring some kind of healthcare response, then any observation that the ambulance service is not the appropriate kind of healthcare response just begs the question about which part of the NHS is the right response?
WHAT IS THE ‘RIGHT CARE’?
I’ve wondered aloud on this blog before whether the “Right Care” actually exists at all – and perhaps that’s why the police became so embroiled in things to start with? It might also be worth wondering what proportion of “mental health calls” to the police are members of the public on social distress because of life events? – we know there is plenty of that going on.
If someone requires a response but an Emergency Department (ED) isn’t correct, the minor injuries unit isn’t correct, a GP isn’t correct and the ambulance service isn’t correct, then what should happen? Mental health nurses I have discussed this with have said to me quite straight-forwardly, “the right care often doesn’t exist” and “that’s why people are bounced around between different parts of the health system and sometimes end up drifting towards the emergency system – police, ambulance or emergency departments.”
It is perhaps in that context Mr Mochrie adds it has been assumed by many, perhaps including some in the police, the ambulance service will just fill any gap left by the police and he does note the National Police Chiefs Council has given support to AACE in making this point: ambulances are often not appropriate either.
So we have a problem here, don’t we? — increasing evidence that calls to the police which are often (NB, but not always!) correctly declined are being passed to another emergency service not necessarily any better placed to provide a response; along with some claims the RCRP threshold is not being correctly applied, to the detriment of patients’ and of paramedics’ safety.
But the concerning aspect of this is the claim by AACE, acknowledged by some in policing, some calls are being inappropriately declined. The AACE letter covers this by stating they have experienced of call handlers declining support where the RCRP Threshold, set out quite plainly in the National Partnership Agreement, is fully met. I think this is what many people worried would happen – it’s all very well having a threshold, but will staff be adequately trained to understand and interpret it, in practice? Fair enough in some forces, the scheme is still new and no doubt bedding in, but how happy are we that “immediate risk to life” is propertly understood by those who have to decide whether a situation amounts to such an emergency?
From some emails I’ve had from mental health professionals (which I obviously have to take at face value without knowing the other perspective from an incident log), we have some concerning examples emerging.
READY
The letter contains one other thing else which I found curious and also lies at the heart of the disquiet about RCRP outside the police. Mr Mochrie regrets the police decision to press ahead with RCRP before NHS trusts were ready – whatever ‘ready’ might mean in this context and it’s this I want to reflect on to end. It’s probably not unfair to wonder if the NHS ever be ‘ready’? – and I don’t wonder this flippantly. Much of what RCRP is aiming to do was sought after and agreed upon during the Crisis Care Concordat (2014) or is contained within previously-agreed multi-agency guidelines on various topics. For example, phase 4 of RCRP is all about the NHS taking over responsibility for patients within an hour of police officers arriving at a Place of Safety, having used powers under s135(1) or s136 of the Mental Health Act 1983.
Well, that was what was agreed as far back as 2011 when the Royal College of Psychiatrists published multi-agency standards agreed to by all the relevant police, health and local authority stakeholders. In fact, RCPsych in 2013 issued further guidance to NHS commissioners on s136 and places of safety where they reduced this 1-hr aspiration to a 30-mins aspiration. So if we all agreed in 2011/13 what should be happening, why are the police here in 2023/24 pushing an initiative which tries to somehow force this to happen? If we cannot work out how to ensure a patient is looked after by healthcare staff in thirteen years, is it not fair to wonder if it will ever happen.
How long is it reasonable to wait before concluding there is no real intent to deliver on those agreements and to then somewhat force the issue, however regrettable it may be to do so? For example, should we wait sixty-five years after publication of the RCPsych document before thinking “OK, they’re probably not going to do this whilst we wait politely, we might need to re-think whether this will ever happen in the real world?” Why sixty-five years, you might ask? – well, that’s how long s140 MHA has been law and we still haven’t seen regular and widespread compliance with the legal duty within so it’s probably safe to wonder about something much less binding like multi-agency guidance from a medical royal college.
The Crisis Care Concordat is ten years’ old this year – and I think it’s legitimate to wonder whether anything within it has been fully delivered, the benefit of patients, the public and the organisations who have to work together. Right Care, Right Person, is borne of an inertia which has lasted decades already but what I suspect to be crucial is this: if you trying to compel others to do something they are reluctant to do, it’s probably best you have your own house in order so that what you are forcing upon them isn’t something that risks their safety, contrary to the way in which you yourself framed the arrangement.
Winner of the President’s Medal, the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation. (c) Michael Brown, 2025
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