Police and Health and Safety Executive investigations are now a feature of the NHS landscape. Any incident that prompts outside investigation will also trigger an internal inquiry.

Multiple investigations raise many questions about precedence and co-operation. Last autumn, the police and Health and Safety Executive closed a consultation on a draft memorandum of understanding. Further work has taken place and a final version may be launched within a few months.

The main points are likely to be:

A framework: there is a broad range of issues that need to be considered, but how they are tackled will be a matter for local agreement.

Trusts should start talking to the police and HSE immediately and not wait for an incident to occur to dust off the memorandum of understanding.

Working together: a key concept is the incident co-ordination group, a working party of senior members of each organisation. This is good but discussion at a senior level has to be translated into clear instructions to, and co-operation between, more junior staff. That needs preparation.

The police take precedence:ultimately, the police will be able to dictate how the investigations progress. Trusts need to explore the requirements of the different organisations and develop ideas on how to meet those needs so there is accommodation, not confrontation.

Releasing information: the requirements of a criminal investigation will dictate a whole range of issues such as who takes initial statements, access to those statements and what staff, patients, families and the press can be told. I n this area the principles of the NHS probably argue for greater openness and less blame than would be appropriate for the police or the Health and Safety Executive, at least in the early stages. Again, do not wait for an incident before discussing these issues.

The test of the memorandum of understanding will be how the discussions at the top filter down to produce real working together. The issues are too complex to be dealt with only after an incident has occurred and trusts should welcome the memorandum of understanding as an opportunity to begin dialogue.

Experience at Tees and North East Yorkshire trust illustrates the point. It has taken four years to implement a local memorandum of understanding on investigating incidents of violence against staff, but the benefits in terms of grass roots co-operation, staff support and high-level contact to sort out problems have been noticed within a short time.

The NHS is seen as unwilling to provide information. This is a misunderstanding of the need to justify breaches of confidence, and it needs to be tackled with a more open discussion than is possible in the aftermath of a serious incident.