Joanna trained as a Registered General Nurse at Manchester Royal Infirmary in 1990 and then went on to work in the Accident & Emergency (A&E) Department, Gynaecology, Oncology and General Surgery. In 2004 Joanna became intrigued by custody nursing after seeing an advertisement for A&E nurses with West Midlands. In 2005 Joanne applied and was successful in getting a post, and she loved it! Joanne found it particularly exciting being part of an emerging speciality and having the opportunity to develop the role. Joanne went on to became a team leader within Custody and became more involved with training, clinical governance activity and identifying best practice.
More recently Joanne became aware that there was a real shortage of female Sexual Offence Examiners to see victims and felt nurses had lots of relevant skills and knowledge they could contribute to ensuring that victims receive a high standard of care. It seemed a natural development for the Forensic Nurse role. In 2009 Joanne decided to do the St Mary’s FMERSA Course. Joanne experienced some hurdles in trying to become a Sexual Offence Examiner and old fashioned views about a nurse’s ability to do this work, but she persevered and became the West Midlands SARC Manager and a Sexual Offence Examiner in 2013.
In 2015 Joanne started her current role as the National SARC Lead for G4S Health, providing leadership and support to the management of six SARC services. As well as being part of the senior clinical team providing healthcare across Secure, Custody and SARC Services.
A review by HM Inspectorate of Constabulary in Scotland (HMICS) into how adult and child victims of sexual crime access forensic medical services has identified significant variations in availability and quality around Scotland, with services offered to some victims being described as ‘unacceptable’.
The report welcomes the announcement of nationwide standards by the Cabinet Secretary for Justice in February 2017 alongside greater clarity around the statutory responsibilities for delivering these services. These will be critical to improving how victims of sexual crime obtain the medical attention they need while ensuring forensic evidence is also gathered for criminal justice processes.
Evidence for the review was gathered over a six month period and identified a number of issues affecting the quality of service delivered to victims of sexual crime in Scotland.
Gill Imery, Assistant Inspector of Constabulary at HMICS, who led the review, said:
“Sexual crimes have a devastating effect on victims and so it is imperative that the support they receive, both from health and criminal justice professionals is high quality and consistent irrespective of where they live.
“The priority of forensic medical examinations should always be to address the immediate health needs and future recovery of the victim, with the gathering of evidence towards potential criminal justice proceedings being an important but not the sole consideration.
“There are many dedicated and committed professionals working across Scotland who are providing quality service to victims, but there is much more to be done if we are to deliver a consistent service which minimises the distress and discomfort to victims who have experienced a sexual crime.”
The report highlighted that the current Memorandum of Understanding (MOU) between Police Scotland and NHS Scotland for the provision of healthcare and forensic medical services should be reviewed urgently.
There is also a need to provide greater clarity around the statutory responsibility for delivering these services.
The review identified ten key recommendations including the need to address the lack of availability of specialist services offered to victims of sexual crime in Glasgow. Although offering a good service to victims, HMICS found that the Archway service in Glasgow was not available for significant periods of time particularly overnight and at weekends, resulting in a ’two-tier’ service being delivered to victims of sexual crime with the alternative service delivered in a police station being described as ‘inadequate’.
The review found that Scotland was well behind the rest of the UK in respect of the availability of dedicated healthcare facilities which meet both the health care needs of victims and the necessary forensic requirements.
The is an urgent need for Police Scotland to work with NHS Boards to identify appropriate healthcare facilities for the forensic medical examination of victims of sexual crime, phasing out of police premises as soon as is practical.
The report also recognises the need to improve forensic cleaning standards in those police custody settings where suspected perpetrators of sexual abuse are examined.
The report also noted that suspects who were under 16 were being forensically examined and within police custody facilities and recommends that Police Scotland works with NHS Scotland to move these examinations into a more appropriate health care setting.
Assistant Inspector of Constabulary Imery said:
“In order to address the current disparity in forensic healthcare services across Scotland, it is clear that further investment will be required to fund appropriate healthcare professionals, including forensic nurses and the premises and equipment used for forensic medical examinations.
“In cases where victims of sexual crime seek support but are unsure whether they wish to report a crime to the police, they must have the option of a forensic medical examination to capture forensic evidence should they subsequently decide to make a report. It is imperative there is clarity around the process of securing and retaining forensic evidence to allow for investigation at a later stage if the victim subsequently chooses to disclose details of the crime.”
“There are a number of examples of how forensic medical services are provided in other countries, with a victim-centred approach, which would be useful for Scottish Government, Police Scotland, the Scottish Police Authority, NHS Boards and other key stakeholders including those that represent victims to consider.
“At present challenges in staffing of services and access to resources, particularly in remote and rural areas where victims may be required to travel some distance to access services, varies greatly and this is to the detriment of victims of sexual crime.
“Our recommendations have been designed to offer suggestions on how to improve the provision of services currently provided to victims of sexual crime so that they can be assured they will receive the best support from the range of agencies and professionals that they may need to engage with, irrespective of where they live in Scotland.”
This professional resource outlines how providers and commissioners can prevent deaths from drug abuse.
Scale of the problem
There were 2,300 drug misuse deaths registered in England in 2015. This represents an increase of 8.5% on the year before and the highest figure on record.
A drug misuse death is defined as a death where:
- the underlying cause is drug abuse or drug dependence
- the underlying cause is drug poisoning and where any of the substances controlled under the Misuse of Drugs Act 1971 are involved
The Office for National Statistics (ONS) publishes data on deaths from drug poisonings in England and Wales and is broken down by cause of death, sex, age and substances involved in the death.
Deaths involving opioids (such as heroin) account for the majority of drug poisoning deaths. Heroin related deaths in England and Wales have more than doubled since 2012 to the highest number since records began 20 years ago.
There are also a small but rising number of deaths involving:
- new psychoactive substances
- prescription and over-the-counter medicines, including pregabalin and tramadol
Further analysis by PHE found that alcohol is mentioned in around a third of drug misuse deaths annually in England, and that heroin-related deaths increasingly also involve other substances.
The majority of drug misuse deaths, 75% in 2012 in England and Wales, are accidental poisonings. The number of suicides among drug misuse deaths is small but steadily rising. PHE’s analysis suggested that suicide was more common in particular groups. Specifically, 38% of drug misuse deaths occurring in 2012 among those aged 45 or over were classed as suicides, as were 34% of deaths among women.
MHRA: ⚠️Hyoscine butylbromide (Buscopan) injection: risk of serious adverse effects in patients with underlying cardiac disease
Hyoscine butylbromide (Buscopan), given intravenously or intramuscularly, is indicated in acute muscular spasm, as in renal or biliary colic; in radiology for differential diagnosis of obstruction and to reduce spasm and pain in pyelography; and in other diagnostic procedures where spasm may be a problem (eg, gastroduodenal endoscopy).
Risk of adverse reactions
We have received 9 reports of patients who died after receiving hyoscine butylbromide injection (including a report from a coroner). In most of these cases, the fatal adverse reaction was reported as acute myocardial infarction or cardiac arrest.
Hyoscine butylbromide injection can cause adverse effects including tachycardia, hypotension, and anaphylaxis. These effects can be more serious in patients with underlying cardiac disease (eg, heart failure, coronary heart disease, cardiac arrhythmia, or hypertension). Several reports have noted that anaphylaxis is more likely to be fatal in patients with underlying coronary heart disease compared with those without.1 2
Reporting of suspected adverse reactions
Suspected adverse reactions should be reported to us on a Yellow Card.
Article citation: Drug Safety Update volume 10 issue 7, February 2017: 1.
Interview Respondents Needed for Research Project:
‘Police Custody Nursing: Ethical, Social, Policy and Professional Challenges’
Nurses are needed for an exciting and ambitious research project investigating the work of healthcare professionals in the police custody environment. Funded by the Wellcome Trust, and working with the United Kingdom Association of Forensic Nurses (UKAFN), Dr Gethin Rees (Newcastle University) is conducting a pilot study exploring all aspects of the everyday work of nurses in the custody environment: from the mundane to the exciting to the downright dreadful, in order to get a sense of what you do and the challenges you face in everyday practice. With this information, Dr Rees will develop a more detailed and specific research project, with the aim of highlighting and addressing some of the key challenges in custody nursing.
If you agree to take part in the pilot study, Dr Rees will interview you at a place of your choosing. The interview will last between an hour and a half and two hours and will include questions relating to your professional background, training and everyday work, amongst others. In accordance with the British Sociological Association’s ethical practice guidance (available at https://www.britsoc.co.uk/equality-diversity/statement-of-ethical-practice/), all interviews will be anonymous and pseudonyms will be used in follow-up publications. While there are no direct benefits at the pilot stage, having the opportunity to reflect upon your work with someone not directly involved can have its own benefits, and you will have the satisfaction of shaping a project that aims to help nurses and other healthcare professionals working in the custody environment in future.
How do I get involved?
If you would like to be part of the pilot project or would like to know more, please e-mail Dr Gethin Rees at firstname.lastname@example.org. More information about Dr Rees and his past research can be found at:
Academics have welcomed the implementation of new minimum standards which apply to health professionals working in police custody and sexual assault settings.
Staffordshire University is currently the only HEI delivering the UKAFN ASET qualification which has been embedded in new Forensic Regulator guidance published in July (HO, 2016).
Concerns about deaths in police custody and harm to vulnerable patients prompted the Faculty of Forensic Medicine (FFLM), the UK Association of Forensic Nurses (UKAFN) and the College of Paramedics, to demand that all healthcare professionals working in police custody and sexual assault settings possess professionally recognised qualifications.
It was similar concerns that prompted Staffordshire University to introduce a Masters in Advanced Forensic Practice, which equips nurses and paramedics with the specialist skills needed to carry out a forensic examination of the alleged victims and perpetrators of sexual assault and of detainees in police custody – a role historically carried out by doctors. The Masters incorporates the UKAFN ASET certificate, the first qualification designed by nurses and paramedics for health professionals working in the specialism.
Marg Bannerman, Associate Professor in Enterprise and Education Development at Staffordshire University, said: “We now have clarity on what training nurses and paramedics practising in this setting should be undertaking and guidance for service providers on how their training budgets should be best spent. We hope that nurses and paramedics will be supported to achieve these standards.”
Now UKAFN and FFLM have publicly agreed that the minimum competency standard for all nurses, paramedics and doctors working in the fields of general forensic medicine or sexual offence medicine, should be either the UKAFN Advanced Standards in Education and Training (ASET) or the Licentiate of the Faculty of Forensic and Legal Medicine (LFFLM).
President of UKAFN, Jennie Smith added: “We are delighted to see the ASET Qualification embedded in the Forensic Regulator’s Standards and feel that this important development will lead to improved levels of service. We look forward to
other HEIs following Staffordshire’s lead and developing dynamic courses with the UKAFN ASET embedded within them.”
President of the FFLM, Jason Payne-James says: “The FFLM warmly welcomes this initiative which reinforces the consensus approach of the clinical partners to define and introduce minimum standards for all healthcare professionals working within the police custodial and sexual assault settings. Police and Crime Commissioners are all now aware of these minimum standards, of which Staffordshire University have also been keen champions. We hope that other HEIs will follow Staffordshire’s important initiative.”
Jaqui Lindridge, a Consultant Paramedic representing the College of Paramedics at the FFLM, added: “The College welcomes the introduction of robust minimum standards in this practice setting and shares the sentiment of our clinical partners in looking forward to the further development of programmes designed to support healthcare professionals in meeting these important standards.”
Mental Health APP is intended to provide guidance to the police service of England and Wales. It is focused on the police response to people who:
- are experiencing mental ill health
- have a learning disability
- have developmental conditions
- have multiple needs relating to mental health
- are mentally or emotionally vulnerable and require assistance.
The guidance highlights the actions and behaviours that may help the police address the needs of mentally vulnerable individuals. The guidance applies whether the police are acting in a criminal justice or health care capacity or in both of these roles. When acting in a criminal justice capacity, the police become involved when a person is a victim of crime, a witness to a crime or is suspected of or known to have committed a crime.
When acting in a healthcare capacity, the police may be:
- acting in support of healthcare agencies that are dealing with someone who is experiencing mental ill health – for example, the police may be exercising specific police powers
- assisting a person who is experiencing mental ill health until healthcare professionals become involved
- responding to families and carers of people with mental ill health or learning disabilities who have concerns about them
- responding to members of the public seeking a service from the police in relation to suspected mental ill health or learning disabilities on the part of an individual.
Mental Health APP has been developed by:
- consolidating and updating existing guidance
- collating professional expertise of police and voluntary sector practitioners
- presenting international and national legislation, statutory codes of practice and relevant case law
- learning from IPCC investigations and reports following deaths, serious injuries and successful interventions in relation to the police response to people who are mentally ill or have learning disabilities.
UKAFN members can access this document in the ‘Members Area’, of the website. The document outlines the expectation that detained individuals are entitled to the same level of standard as any other ED patient.
The document outlines the kind of setting a care delivery available in the custody setting. Advising that there should be no difference between discharging an individual home and to custody.
Finally, the document gives a brief of the level of information that the ED should be given from the referring clinician in the custody suite.