Over To You (Part 1)

On Sunday 21st December I started a series of tweets about risk: the management thereof and how police absorb and inherit it from others. Several hours later, I realised that I should probably have turned them into a blog but once I had started it become a stream of consciousness that was difficult to stop. This blog, therefore, is an attempt to convert those tweets into something a little more structured and coherent.

Policing is all about risk management. At its most fundamental it is about reducing the risk of crime or even reducing the risk of the occurrence of crime. When crimes are committed it is about investigating and finding the offender with a view to reducing the risk of further offending.

When a dangerous situation occurs it is about minimising risk. The same could be said of counter-terrorism, dealing with domestic abuse or dangerous offenders.

The world is full of dangerous people and it is the role of the police to identify the risks they pose and to mitigate that risk. It is also the role of the police to identify and protect those most AT risk and there probably more of them than there are dangerous people.

It is an enormous and never ending task often undertaken with little time and with barely enough resources. The landscape of risk is forever moving, changing and growing. New threats emerge and everything needs to be assessed and decisions made on what, if any, action needs to be taken to counter them. Sometimes these decisions need to be taken in minutes or even seconds.

Police often deal with risk at it’s most extreme – at crisis point. Whether that be individual crisis or situational crisis it often means that events have already taken a dangerous turn and something has to be done, quickly, to bring something to a safe conclusion.

Sunday’s tweets started with some commentary on the decision (currently under consideration) to reduce the targets for ambulance arrival times. The cynical view on this is that the ambulance service is clearly struggling to meet the target times which currently exist and so it is politically convenient to relax them. That way, performance doesn’t have to improve but politicians and NHS trusts could still say, with statistical confidence, that targets were being met. No problem exists – nothing to see here – move along.

A few years ago, a colleague of mine was critically injured on duty. Everyone at the scene could see how serious the injury was and the pleading radio transmissions – begging for medical assistance – will live in my memory for ever.

The problem was that there was no ambulance. A single crewed paramedic was on scene very quickly and did everything they could to stabilise the officer but their professional medical view was that the officer needed to be conveyed to hospital – urgently – on a spine board. The paramedic could not achieve this in a Ford Focus estate and needed a full size and properly equipped vehicle immediately.

The officer had not regained consciousness and there were serious and very real concerns that they might not survive. Still no ambulance.

Desperate colleagues flagged down passing ambulances only to be told that they were not allowed to redeploy. One officer came across an ambulance only two streets away and they radioed in and were told they could not redeploy. Another officer, passing the local hospital, drove in and saw numerous ambulances at A&E. Most had patients stuck in them but not one of them was allowed to redeploy.

Tension between us and the ambulance service reached nuclear levels. None of us could understand why they were refusing to help and come to our colleagues aid when it looked like they weren’t doing anything more important.

Eventually, after a very long time – too long – an ambulance arrived from another county and the officer was conveyed to hospital. It was touch and go for about 48 hours and several operations later the officer was declared critical but stable. They went on to make a phenomenal recovery.

Unsurprisingly, we made an official complaint to the ambulance about their response. They refused to accept that there was a problem. Their answer was that they had responded within the target time of 8 minutes.

The fact is that they had. The fact that the unit sent was a single crewed paramedic who could not fully and properly deal with what he was faced with didn’t matter. I have no doubt that the actions of this paramedic saved the officer’s life but had the situation gone on much longer I am also convinced that the outcome would have been tragically different.

The need for the second, fully equipped ambulance, was not something which required adherence to a target. New calls did – no matter, it seemed, what they were. Rather than send the nearest ambulance (from two streets away and was dealing with something less severe) they sent one from another county. No ambulance was allowed to divert from whatever else it was being sent to.

The official response was as heartless as it was surprising. You had a trained paramedic there within 8 minutes therefore we achieved our target and that’s it. The fact that it couldn’t effectively deal with the situation was, apparently, irrelevant.

The police have been behaving like this for years. I am sure it has been unintentional but now I look back at it there are similarities.

For over a decade the main crimes the police have been obsessing about have been what we called “volume crime.” This was government driven, of course, but the crimes which counted, the ones we had to reduce and detect and were held account over were burglary, robbery and theft of and from motor vehicles.

Inordinate amounts of police time and resources were spent focussing, slavishly, on addressing these. It led to the target culture which is now, almost universally, recognised as having been entirely counter-productive.

Government ministers and senior officers were able to confidently face the media and say that crime was falling and the police were doing a good job because all the numbers were pointing in the right direction.

Except – what we were actually doing was focussing on crime types rather than victims.

The situation still exists. HMIC have recently published a series of inspection reports and some forces have been criticised for still having mandated response times for attendance at burglaries. The instruction is that officers must attend the scene of a burglary within an hour or be prepared to explain why this hasn’t happened.

Following the rule of “what gets measured gets done” – with burglary under the microscope it meant that all burglaries became a priority over other things. There was no such mandated response time for incidents of domestic abuse. Therefore, by default, a burglary took precedence over a report of domestic violence (unless, of course, the domestic violence was reported as “happening now”.)

Now, it seems, that by focussing so heavily on volume crimes as defined by the government, they have missed many other types of volume crime (such as domestic abuse) which were happening all the time and were, in fact, far more dangerous.

As unpleasant, intrusive and frightening as a burglary is – the risk posed to the victim from domestic abuse is invariably far greater.

It seems, unfortunately, that police have also missed an entire generation (possibly plural) of child abuse as well.

Anti-social behaviour is the same. This became a hot-topic about 10-15 years ago and became increasingly so within the last 5 years. But it wasn’t until the tragic case of Fiona Pilkington occurred that the penny dropped that individual people react differently to events. Where some people are able to shrug things off and deal with them – for others it really isn’t that easy.

Even something as apparently (as it was viewed) trivial as persistent nuisance caused by young people can have terrible consequences.

A one size fits all approach (such as attend burglaries in an hour – or else) is blunt and ineffective. In the ideal world we wouldn’t focus on types of crime by heading but respond according to an individual victim’s personal circumstances and needs.

We still don’t get this right.

The solution now is to use risk assessments for various crime types. They are now commonly used for instances of domestic abuse and reports of anti-social behaviour. Every victim is taken through a questionnaire which, via a matrix of scores, is intended to identify their potential level of risk. They will then receive a service tailored to that level of risk.

Unsurprisingly, there is a lot more risk out there than was perhaps previously considered. This process has led to there being a lot more “high risk” situations out there than perhaps was known about. They were always there – we just didn’t appreciate them before.

Whilst it is good that this is now being identified and considered it has led to a problem. There is probably more “high risk” out there than can be reasonably managed.

Every force has a multi-agency group which meets to consider the high risk cases. This will consist of police, social services, housing agencies and other support organisations. The purpose is to discuss the high risk cases and ensure that everyone who can is doing what they can and should to support those identified as needing it.

You may have guessed the problem already. As the number of high risk cases has gone up – the threshold which needs to be met to achieve discussion at this group has also gone up. So it is now discussing the highest of the highest risk cases.

This is fine until you consider that those cases which might not be the highest of the highest risk – are still classified as high risk.

This group does good work and saves lives but the number of high risk cases has the potential to continually increase to the point where it becomes unmanageable.

If things reach that point it will be impossible to do what is being considered with the ambulance service response time targets and change the threshold.

In the next blog I will attempt to explain why.

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One response to “Over To You (Part 1)”

  1. Clive says :

    The ambulance service application of targets that you describe produced an outcome predictable to a systems engineer: it created ‘failure demand’ downstream. Instead of seeing a patient in surgery within an hour of first contact (critical for good outcome), they used a pointless and irrelevant but easily reportable measure for some bureaucrat somewhere to produce a report that would never be read. The result added to the human dimension, and the absorption of police resources that you describe, would have been the added medical costs of delayed treatment. A dumb all round outcome!

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