Trust CEOs accuse police of ‘high stakes game of chicken’

The Association of Ambulance Chief Executives say in a newly published letter they believe the “spirit” of national agreement on how to implement the Right Care, Right Person model is not being followed by police, raising “significant safety concerns”.

The membership body set out multiple concerns about the rollout of the model, under which the police refuse to attend mental health calls unless there is a risk to life or of serious harm.

The NHS has agreed to move to the approach – designed to reduce the growing number of incidents police attend which they deem inappropriate – but it appears to have encountered major problems. 

In the letter to Commons health and social care committee chair Steve Brine, AACE chair Daren Mochrie says timescales for introducing it were often “set by the police rather than “agreed” following meaningful engagement with partners”, meaning demand was shifting before health systems had built capacity. They also flag a lack of NHS funding to meet the new asks. 

Mr Mochrie, also CEO of North West Ambulance Service Trust, described a “grey area” relating to what he called “concern for welfare” calls, which meet neither the police nor attendance services’ threshold for attendance.

“To date this is the single biggest feedback theme we have heard from ambulance services, with some control room staff describing feeling like they’re in a ‘high-stakes game of chicken’ where the police have refused to attend and told the caller to hang up, redial 999 and ask for an ambulance,” he wrote.

The letter was sent on 31 January but published on Tuesday by the select committee.

Mr Mochrie said AACE was particularly concerned by reports of police not attending incidents when requested to provide support, which have subsequently resulted in patient harm or ambulance clinicians being assaulted.

“These are incidents that would appear to meet the [agreed] threshold for police attendance… But feedback from other areas suggests there may be excessive over-application of RCRP in some police forces,” he wrote.

“Feedback from one ambulance service indicates that since March 2023 staff have raised concern in relation to 160 incidents citing RCRP as a factor, with 33 incidents involving some degree of harm.”

Scale of demand in London

Mr Mochie was critical of the lack of a “full multi-agency evaluation and impact assessment of RCRP prior to initiating a national rollout” and said early data from London Ambulance Service suggested it was receiving an additional 200-250 transferred incidents each day. 

He said it was concerning LAS was receiving around 400 incidents per month relating to concerns for welfare from healthcare professionals, as the ambulance service was now the new “default” response.

According to AACE, LAS anticipates that the additional revenue cost of RCRP will be £4.7m for 2024-25, with a “full year effect” of £6.8m in 2025-26.

“As yet, this new activity is unfunded by [integrated care boards] and to be fair to them they have received no additional funding to reflect the transfer of work from the police.

“We are not able to extrapolate from the LAS estimates full national cost implications for ambulance services arising from the rollout of RCRP, but the LAS data indicates that the investment needed to maintain public safety for this vulnerable group of patients will be significant.”

Although Mr Mochie acknowledged most regions had not yet experienced such a significant shift, he warned AACE was “surprised that such a significant system change – with such clear risks for some of the most vulnerable people in society – has gained so much momentum in the absence of a full understanding of the impact”.

The RCRP model was first introduced in Humberside over several years.

The membership body set out multiple concerns about the newly rolled-out model – which was first trialled in Humberside over several years and involves officers only attending mental health calls where there is a risk to life or serious harm.

NHS agreement to make the change was only reached last year, after an ultimatum from the Metropolitan Police.

At the time, the Met police commissioner said there was an “urgent” need to introduce the model in London, and cited findings from a national police review which suggested officers across all forces were spending just under a million hours per year with mental health patients in hospitals waiting for assessment. This time could have been spent responding to the equivalent of 500,000 domestic abuse incidents or 600,000 burglaries, he said.

Assistant chief constable Jenny Gilmer, National Police Chiefs’ Council lead for Right Care, Right Person said: “We recognise the complexity of the landscape and at both a local and national level we work closely with partners to ensure the safe and effective roll out of RCRP. We have an established escalation process where we welcome partners raising issues and concerns so we can work through these together. Each local force will set their own timescales and we do believe these are largely achievable.

“Policing works closely with and in support of our emergency service partners and Right Care Right Person does not change our commitment to respond to an incident or situation where there is a risk of harm.

“We are grateful to AACE for their support of the Right Care Right Person approach and thank them for raising these challenges which we will now work through.”

*Amended at 12.40 on 22 February to add the NPCC’s response