Source · IOPC Learning Case

National recommendation - National Police Chiefs' Council, April 2019

Ref: 2018/101082 Recommended 12 Apr 2019 Response due 7 Jun 2019

Custody and detention Death and serious injury

The recommendation below arises from a Death or Serious Injury review by one of our Casework Managers of a police investigation into the circumstances in which a detainee self-harmed: the detained person, who used a disabled toilet near the custody desk, removed the alarm cord in the toilet, concealed it on their person and used it as a ligature when back in their cell, causing themselves to become unresponsive.

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Recommendations

1 total

Recommendation 1

The IOPC recommends that the National Police Chiefs' Council (NPCC) ensures that all forces are made aware of this risk and the injury caused by the use of an alarm cord as a ligature in this case. All forces should be advised to review their own custody facilities as a matter of urgency to ensure that any cords that could present a similar risk are replaced with alternative means of raising alarm, which cannot be used as a ligature. The National Police Estates Group should be advised that this measure is incorporated into guidance for any new facilities or refurbishments. Do you accept the recommendation? Yes

Addressed to: National Police Chiefs Council

Linked bodies: National Police Chiefs Council

Accepted

Force response

Accepted action: The NPCC will communicate the recommendation with a note advising all forces to review their own custody facilities as a matter of urgency to ensure that any cords that could present a similar risk are replaced with alternative means of raising alarm, which cannot be used as a ligature. The advice will be sent to all custody leads through the NPCC Custody portfolio forum. It will also be uploaded to NPCC Chiefs Net to ensure a wider police audience have access to the recommendations. The NPCC to also promote the recommendation at their 2019 custody forums. Impact of the recommendation can be monitored through feedback from Her Majesty’s Inspectorate of Constabulary and Fire & Rescue Services visits.