Portrait of nurse leaning on railing

Treatment in custody is now mainly led by nurses and paramedics, instead of doctors.

Photograph: Image Source/Alamy Stock Photo/Alamy Stock Photo

Six years ago, Sara Elias found her true passion when she left an A&E nursing job to work in police custody. This year, a move to service provider Mountain Healthcare as a full-time custody healthcare professional has brought even greater opportunities for professional fulfilment.

Elias, who is based at a West Midlands police station, is responsible for the medical wellbeing of people in custody. When someone is arrested, she has to determine whether they are fit to be detained. “A lot of the people we see have medical problems, substance dependencies, or they might have injuries or mental health issues or be intoxicated.” If they can be detained, she has to determine whether they’re sober enough to be interviewed – a formal interview carried out while someone is drunk would not be admissible as evidence.

Elias also has to treat injuries, manage substance withdrawal, refer suspects to the mental health team and take forensic samples such as blood, hair combings or clippings. Sometimes she will send a detainee on to hospital or aftercare services once they are released.

Working for Mountain Healthcare has given Elias the chance to take on skills and responsibilities not available to her in previous jobs. “The wealth of training available is amazing. I’ve learned things I never thought possible because historically custody nursing was a doctor-led service. Now, we’re very much a nurse and paramedic-led service. The onus is on us to take on extra skills.”

Those skills are varied – Elias has recently completed a Taser injury course, as well as training on caring for pregnant women in custody. She is now the link nurse between the police station and the local hospital’s team of midwives, in the care of vulnerable women. “We work quite closely together to forge links outside the police station. This is stuff we’d never have been able to do before. It’s not a job now – it’s a career.”

Since it launched in 2014, Mountain Healthcare has grown to 350 employees, most of whom are clinical staff. Headquartered in Essex, the business, which is regulated by the Care Quality Commission, provides healthcare to those in police custody and services to those who have experienced sexual assault or abuse. The company is commissioned by NHS England and the police, but the directors are passionate about the fact that working with those who are vulnerable at a point of crisis offers a unique opportunity to make a difference. Staff are based in police stations and in Sexual Assault Referral Centres (Sarcs) in 14 English counties, working with children, young people and adults.

This type of specialist work requires skilled and sensitive professionals, says Natasha Green, Mountain Healthcare’s head of HR. The forensic service for sexual assault involves dealing with people shortly after they have reported a crime: “The police call our pathway coordination team when someone reports a sexual assault or rape. We then arrange for them to go into one of our centres, and we provide a nurse and a crisis worker to take them through the forensic examination and any aftercare needs that they may have.” Individuals can also contact a Sarc directly – where the team can coordinate care, carry out a holistic assessment and support medical needs but also collect evidence that gives service users the option to report the incident to the police at a later date if they prefer.

Associate medical director Kate Shardlow enjoys the variety her job provides. She’s responsible for a team of clinicians working in paediatrics and adult sexual offence, and is also the lead safeguarding doctor. As well as performing a managerial role, she works in a small team two or three days a week, examining children who may have been sexually abused and writing medico-legal reports for court. Mountain Healthcare, she says, is “a dynamic company – it’s quite exciting if you’re looking for new opportunities and career progression”.

Staff roles are highly specialised and include doctors, nurses, paramedics, crisis workers, independent sexual violence advisers and wider roles such as pathway and support co-ordinators. When recruiting for Sarc positions, Mountain Healthcare looks for empathetic professionals, says Green, with a background in sexual health or working in safeguarding. GPs, with a specialist interest, as well as wider specialities, enjoy their role and being able to make a difference. Crisis workers typically have experience in advocacy work or social services, while police custody staff have backgrounds in A&E or working within prison healthcare. “They need to be quite experienced because, although they have lots of support around them, in most custodies you have one nurse or paramedic on shift at a time.”

Clinical staff are offered extensive training opportunities and are closely mentored. Mountain Healthcare also provides an out-of-programme experience or preceptorship, allowing staff to work for Mountain Healthcare for a short period providing a break from their main role, often welcomed by doctors on speciality training.

Emelia Spencer, a nurse who joined Mountain Healthcare in 2016 as head of healthcare, is now director of nursing and the contract manager for the north of England. She is responsible for four Sarc managers, all of whom are qualified forensic nurse examiners, and makes sure that each centre is meeting quality standards, as well as managing contracts with NHS commissioners.

Her time at Mountain Healthcare has been particularly fulfilling professionally – and she also finds it an immensely supportive environment. “Mountain Healthcare is the only company I have ever worked for where I could truly say it is dedicated to its staff as well as what it’s delivering. You’re not a number – everybody’s name is known. Your wellbeing is really important. There isn’t a hierarchical kind of culture.” The company places a high value on personal touches, she adds: all staff receive a personally signed card on their birthday and gain access to numerous team building events, staff award ceremonies and regular charity fundraising projects, just to name a few.

Shardlow agrees that Mountain Healthcare offers an experience that isn’t available anywhere else. “It’s a very forward-thinking organisation – always looking for new ideas and new opportunities, and everybody has a voice.”


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