Right Care, Right Person

Question 1

Executive summary

Accepted Answer

Introduction

When people are in mental health crisis, they need timely access to support that is compassionate and meets their needs. Right Care, Right Person (RCRP) is designed to ensure that people of all ages, who have health and/or social care needs, are responded to by the right person, with the right skills, training and experience to best meet their needs (GOV.UK, 2023a). RCRP applies to those with mental health, and other health and social care, needs. In most circumstances, support will be provided by health and social care services.

In November 2022, the Policing Productivity Review (PPR) recommended implementation of the RCRP approach across England and Wales. In December 2022, the National Police Chiefs’ Council’s (NPCC) ‘Chiefs Council’ forum agreed that all territorial forces in England and Wales would implement RCRP.

A joint approach across a range of partner agencies is required for RCRP to be implemented. In July 2023, the National Partnership Agreement (NPA) was published. This set out a collective national commitment from the Home Office (HO), the Department of Health & Social Care (DHSC), the NPCC, the Association of Police and Crime Commissioners (APCC), the College of Policing (CoP) and NHS England (NHSE) to work to support the end of inappropriate and avoidable involvement of police in responding to incidents involving people with mental health needs. The CoP, working with the NPCC and other partners, produced a toolkit to support the implementation of RCRP in 2023. These included ‘smarter practice’ guidance and sections relating to partnership working, legal advice and data monitoring. Additional guidance from the CoP relating to children and guidance from other partners were published in 2024, after the research for this evaluation had been conducted (APCC, 2024; CoP, 2023a)

This evaluation was conducted to understand how RCRP is being implemented and to share findings to aid ongoing implementation, by analysing evidence from a sample of police forces, integrated care boards (ICBs) and local authorities (LAs) across England. HO and DHSC analysts have evaluated the implementation of RCRP through a rapid process evaluation covering police, fire, health and social care. HO research activities included a qualitative data gathering exercise from 3 police forces. Interviews were conducted with area managers from the fire and rescue service (FRS) from the same 3 police force areas. HO analysts also analysed quantitative data from 5 police forces to assess any early changes in RCRP related deployments and to calculate the estimated impact on police officer hours saved. DHSC research activities included surveys with ICBs and LAs. Qualitative evidence, comprising interviews with frontline health, social care and voluntary, community, faith, and social enterprise sector staff, was commissioned via the call-off analytical facility (CAF) which was delivered by a team of independent researchers from the University of York and the King’s Fund. All research took place between autumn 2023 and spring 2024 (Jefferson, et al., 2024).

Key findings

Good practices in implementation

Several factors have been identified and implemented that could contribute to the successful implementation of RCRP. Communication and engagement were identified by the police, health and social care and FRS as being crucial when implementing RCRP. The sharing of information and knowledge improved understanding of RCRP and partners’ responsibilities. Through early engagement with multiple partners and bringing them into discussions, police and partners could better understand each other’s workload and demand requirements. The research found that positive partnership working and building strong relationships contributed to a supportive experience when implementing RCRP. Collaboratively reviewing and monitoring RCRP implementation and sharing information about reviews, escalation and safety protocols were also identified as important for good decision making and successful implementation. Other good practices identified and being implemented were having regular discussions with partners, taking a phased approach to RCRP implementation, having single points of contact (SPOC), providing adequate training, and ensuring the monitoring of data.

Partnership working

Overall, the research found that police, ICB and LA staff felt that collaborative partnership working had improved since RCRP had been implemented. Where there was broad involvement of partners, relationships were reported to have improved. RCRP was reported as providing an opportunity for better decision making and joined up working with partners to learn more about their roles and responsibilities. However, challenges remain. At operational levels in policing, some practical limitations were identified, such as when making decisions that can be difficult for partners to deliver due to funding or resourcing constraints. Health and social care staff noted that a positive partnership working experience was not universal across those implementing RCRP. This was specifically reported by LAs, where they had felt less involved in RCRP decision making. It was also identified that several stakeholders were not routinely included in discussions around RCRP, such as children and young people’s services. However, police respondents acknowledged good practice in engaging with children and adult safeguarding teams, including working through those teams’ initial reservations.

Barriers to implementation

The main barrier to RCRP implementation was identified as capacity and resourcing limitations within health and social care for responding to incidents that had been dealt with by the police before the introduction of RCRP. Absorbing this demand has been made more challenging by wider increases in demand for health and social care services and ongoing resource challenges in many ICBs and LAs. General demand for mental health services is highlighted in referral data that shows adult mental health referrals have been increasing at a rate of 3% a year and referrals for children and young people have increased by 12% a year in the last decade, demonstrating the ongoing resource pressures in the healthcare system (Darzi, 2024).

Capacity and resourcing limitations within health and social care were recognised at operational and strategic levels in policing. Police staff understood that following RCRP implementation, partners’ ability to accept their duty of care can be constrained, but this can lead to police taking responsibility for incidents unnecessarily and inconsistency in their decision making. Police reported the setup of oversight groups with ICBs and other multi-agency groups, to support partners in sharing concerns around RCRP and feed into the RCRP approach being undertaken, as helping to mitigate any tensions. Cost and funding pressures faced by ICBs and LAs were identified as a challenge to health and social care moving forward with RCRP.

Unintended consequences, risks, and learning

A key risk identified by ICBs, LAs and the police was potential gaps in services. These gaps could result from a lack of clarity about who should respond to certain calls or inconsistent decisions being made. Decision making can be difficult for control room staff, incidents are often not clear cut, and decisions are based on information staff are provided with, which can be incomplete. Police reported a collaborative approach with partners, which helped in understanding the phased approach and allowed partners to voice their concern about any potential gaps in service. Police said implementation was an iterative process where any concerns raised were considered through checkpoint reviews before each phase, and policies amended as appropriate. Health and social care staff felt there was not always a consistent approach to certain call types. They said that a possible consequence is the public perception that police are not dealing with certain types of calls, so they may not call the police, but may also not know who to call when help is needed. Linked to this, there were reported concerns from ambulance services that they may not be the most appropriate agency to respond to certain call types that are being transferred to them instead of the police, especially where the call does not relate to a health concern. FRS may be called to deal with incidents but reported that they are sometimes being inappropriately called upon to obtain entry to a building when they do not have the power to do so under the Fire and Rescue Services Act 2004. The police and FRS both voiced concerns about calls being made by the ambulance service that appeared to adapt the information being provided to ensure their response and attendance at an incident. Police reported that when they have made follow-up calls with people requesting assistance, the incident may sometimes be less serious than had been reported to them by the ambulance service, and the response may be less urgent than initially requested, or their attendance may not be required. However, ambulance services and approved mental health professionals (AMHPs) have reported concerns for staff safety, particularly where staff have neither the same training in patient restraint techniques, nor the same power to detain them, as the police.

Early perceived impacts of RCRP

Police reported a perceived reduction in demand, with less time spent dealing with certain incidents and a perceived reduction in calls from partner agencies. Police perceive that their workload and the number of calls were more manageable, resulting in a better service for the public, with partners and the police dealing with the incidents they are trained and responsible for.

In response to the DHSC survey question asking whether they expected an increase in demand on services, ICBs and LAs reported that they expect more demand on services, especially for mental health crisis teams and lines, ambulance services, and urgent and emergency care. Concerns were voiced about the system’s capacity to successfully take on the demand following RCRP implementation without detriment to other services.

Police data monitoring

Police perceptions of a reduction in demand were supported by a quantitative analysis of police incident data. For the forces sampled, there was found to be a reduction in the number of calls about ‘concern for safety’ incidents received each month and the number of these incidents deployed to, following the implementation of RCRP. Estimates suggest that each of the forces sampled saved officer time as a result of these reductions. A reduction in demand for these types of incidents means that this time can be reinvested elsewhere, enabling police to focus on their core duties.

Conclusions

The findings highlight the importance of communication, openness and transparency when implementing RCRP across multiple agencies. While generally supportive of RCRP principles, research participants highlighted challenges with implementation, such as a high demand on (mental) health services, while simultaneously not feeling adequately resourced. Participants also expressed concerns about operational challenges, such as insufficient clarity about roles and responsibilities, potential gaps in service delivery and inconsistent decision making. Where gaps in service had been identified, actions have been taken to address any potential risk through partnership communications and escalation routes. Early data shows that RCRP has led to a reduction of police time spent on RCRP related incidents. Findings were fed into the system in real time to support and enhance activity as RCRP was rolled out.

From this research, it is recommended that good practice to support the implementation of RCRP involves:

multi-agency working groups meeting regularly to discuss implementation plans openly
internal communication within organisations so everyone understands the RCRP approach and external communication with partners
sharing of learning between partner organisations and across areas
adequate training for staff, ensuring legal responsibilities and guidelines are followed
effective safety protocols and single points of contact to facilitate communication
a phased implementation approach
establishing robust and trusted escalation processes for reviewing incidents

Question 2

1.  Introduction

Accepted Answer

1.1 Background

1.1.1 Policing and mental health

When people are in a mental health crisis, they need timely access to support that is compassionate and meets their needs. In most circumstances, this support is best provided by health and social care services. The police’s recent focus has been on reducing the role of policing in responding to people in need of mental health support, and on ensuring that these people receive support from the right service.

Policing comprises a broad spectrum of work. The 2023 NPCC Policing Productivity Review (PPR; HO, 2023) summarised the police role as including:

work that only the police can do because it requires the exercise of their unique powers
work undertaken by the police to meet their obligations within the criminal justice service (such as, seeking justice outcomes)
joint multi-agency partnership work that seeks to solve societal, community-based problems (crime and non-crime) or addresses specific offender management issues

Mental health can be a factor in all these areas of police work. People with mental health needs may be the perpetrators of crime, or more likely the victims of crime, or they may come to the attention of the police because they pose an immediate and serious risk to themselves or others (Buckley, n.d.; HO, 2023).

Joint multi-agency work provides an opportunity to develop effective partnership working arrangements at a local level to ensure people in mental health crisis are responded to by an appropriate person. In recent decades, there have been several major changes to these multi-agency arrangements and the role of policing in mental health. There have been several national projects, such as the Crisis Care Concordat (CCC; DHSC & HO, 2014) which set out a strategic direction for the roles of local partners in responding to people in mental health crisis. Reform to legislation on the use of police stations as places of safety under the Mental Health Act (MHA) has substantially reduced the number of people in crisis held in a police cell, and the draft Mental Health Bill proposes would remove this as an option entirely (DHSC & MoJ, 2022).

Previous governments’ multi-agency crisis strategies and initiatives, most notably the CCC (published under the 2010 to 2015 Conservative and Liberal Democrats coalition government), recognised that police officers play a critical role during their work in helping people with mental health needs and in guiding them to the most appropriate care, and the police can have a legitimate role in dealing with individuals who are suffering mental ill-health (DHSC & HO, 2014). The NPCC Mental Health Strategy 2022 - 2025 also highlights that the police do have a role in responding to people suffering mental ill health (NPCC, 2022). Nevertheless, professionals with the right training, skills and expertise are often best placed to respond to people in crisis. An independent review of the MHA recommended that people requiring mental health care should not be pushed into the Criminal Justice System, which is not able to or intended to care for their needs (DHSC, 2018). Use of crisis mental health services has increased by one-third since before the pandemic and doubled since 2017 (RCPsych, 2022). Despite investment and increases in service capacity, health systems have faced ongoing pressures, and police officers have increasingly been called upon to respond to people with mental health needs.

1.1.2 Police demand and mental health incidents

In 2018, His Majesty’s Inspectorate of Constabulary and Fire & Rescue Services (HMICFRS) inspected the activities of all 43 police forces in England and Wales and the British Transport Police relating to mental health (HMICFRS, 2018). HMICFRS found police officers’ involvement in mental health incidents included:

helping to transport an individual to hospital when an ambulance was not available
waiting with an individual in hospital until a mental health setting, where they can be cared for, was confirmed
checking on an individual after concerns had been raised for their safety

In summer 2022, the HO commissioned the NPCC to lead on a review of productivity in policing. The NPCC worked with all 43 police forces in England and Wales to produce a snapshot of 24 hours of mental ill health related demand in October 2022. In October 2023, the PPR found that police reported concerns around the pressures of dealing with incidents that involve mental health (HO, 2023). While some incidents involving mental health do require police attendance (for example, where there is a risk of serious harm or to exercise police powers under the Mental Health Act 1983), the PPR suggested that 45% of incidents reviewed involved no immediate threat of serious injury, nor any crime. For many of these ‘non-crime no immediate threat’ incidents, the PPR report stated it would be appropriate for people in mental health need to receive a response from a health or social care professional rather than a police officer.

Where police officers have used the power in section 136 of the Mental Health Act 1983 (s136) to take someone to (or keep them in) a ‘place of safety’ for assessment by professionals, that place of safety should ideally (unless the individual has physical health needs which require urgent attention) be a health-based place of safety (HBPoS). HO (2024a) data showed that in the year ending March 2024, there were 31,213 detentions under s136 powers; this was a 10% decrease compared with the previous year (excluding Devon and Cornwall police). Following a detention under section 136 of the Mental Health Act, a place of safety was recorded in 90% of cases. Of the cases where the place of safety was known, 52% of detainees were taken to a HBPoS. In 46% of cases for the year ending March 2024, the individual was taken to an emergency department (ED), this will include people who required treatment for physical injuries alongside a mental health assessment - for example, someone who may have self-harmed (HO, 2024a).

The PPR argued that police officers are spending “unacceptable amounts of time safeguarding these patients while they wait for assessment”, especially in EDs. The review estimated that police officers spent 800,000 hours annually waiting with mental health patients. The PPR reported that reducing handover times could free up police resource while also benefiting patients as they are likely to receive more timely access to support from a health care professional. In its 2018 report, HMICFRS also expressed ‘significant concerns’ regarding the amount of police time spent responding to mental health problems, including the transportation of people to hospital, or checking on someone if there are concerns for their safety (HMICFRS, 2018).

Lord Darzi’s review of the NHS reported an increase in demand for health, social care and mental health services from 2016 to 2024 (Darzi, 2024). In 2016, around 2.6 million people were in contact with mental health services, this increased to 3.6 million people by 2024. For adults, mental health referrals have been increasing by 3% per year over this period. For children and young people, the rate of referrals has increased by 12%, from around 40,000 a month in 2016 to almost 120,000 a month in 2024 (Darzi, 2024).

In January 2023 (before the rollout of RCRP commenced), £150 million capital funding was announced to ease pressure on mental health urgent and emergency care services. This funding is being used to deliver 24/7 NHS access to urgent mental health helplines, new mental health ambulances, and alternatives to support hospital admissions (GOV.UK, 2023b).

Additionally, the NHS 111 option 2 service for mental health support became available nationwide in August 2024 to help more individuals experiencing a mental health crisis receive timely support (NHSE, 2024a).

1.1.4 Right Care, Right Person approach

The Right Care, Right Person (RCRP) approach was developed in Humberside Police over a 3-year period from 2019. In November 2022, the PPR recommended implementation of the RCRP approach across England and Wales and in December 2022, the NPCC ‘Chiefs Council’ forum agreed that all territorial forces in England and Wales would implement the RCRP approach. RCRP is designed to ensure that people of all ages, who have health and/or social care needs, are responded to by the right person, with the right skills, training, and experience to best meet those needs. As such RCRP was developed in relation to mental health as well as wider health and social care issues.

Humberside Police implemented RCRP through a phased implementation approach (CoP, 2023b). The CoP (2023c) baselining and evaluation criteria sets out the 4-phase approach to RCRP implementation as:

phase 1 - concern for welfare
- example concern for welfare: mental health services reporting that an individual had not attended their appointment the previous day, and they had significant concerns about them due to their recent presentation
phase 2 - walk out of healthcare facilities and absent without leave (AWOL) from a mental health establishment
- example walk out of healthcare: call from ED of an acute hospital regarding a male who had left before being discharged with a cannula in his hand, police were asked to locate him
- example AWOL: a sectioned patient had gone AWOL after s17 escorted leave with staff, last seen in the pub - later located at their home address by officers and returned to the mental health unit (a responsible physician may grant a person leave to be absent from the hospital, which may be subject to conditions, such as being escorted)
phase 3 - transportation of patients
- example transportation: police asked to convey patients (from acute hospital to mental health facilities) or police conveying s136 or voluntary mental health patients to places of safety
phase 4 - section 136 of the Mental Health Act and voluntary mental health patients
- example s136: s136 is used to detain someone in crisis - police attend the s136 suite but could not handover to clinicians as no one was free to accept and police remained for 12 hours

Although RCRP guidance recommends a phased approach for structuring RCRP implementation, forces have the operational independence to decide to apply RCRP differently. For example, some forces have implemented phases in different orders, or all phases at the same time.

For RCRP as an approach, partnership working is crucial between police and local health and social care agencies, including ambulance services, mental health services and acute hospitals, along with voluntary, community, faith and social enterprise (VCFSE) sector services. Partners need to work together to ensure that patients receive timely care from the most appropriate agency which can best meet their needs.

At the core of the RCRP approach is a threshold to assist police in making decisions about when it is appropriate for them to deploy resource, and how best to respond to incidents. It is important to distinguish this threshold from the police’s statutory powers and duties, which are not impacted by RCRP. The threshold for police deployment to an incident is:

to investigate a crime that has occurred or is occurring
to protect people, when there is a real and immediate risk to the life of a person, or of a person being subject to or at risk of serious harm (GOV.UK, 2023a)

1.1.5 National Partnership Agreement (NPA)

Police forces have operational independence, but to successfully adopt the RCRP approach, strong partnerships needed to be formed between police forces and health and LAs, which required a joint approach across a range of partner agencies. In July 2023, the NPA was published (GOV.UK, 2023a). This set out a collective national commitment in England from the HO, DHSC, the NPCC, the APCC, the CoP and NHSE to work to end the inappropriate and avoidable involvement of police in responding to incidents involving people with mental health needs. The NPA highlighted that where it is appropriate for the police to be involved in responding, it will continue to happen, but the police should only be involved for as long as is necessary, and in conjunction with health and/or social care services.

The NPA focused on the interface between policing and mental health services, as one step towards implementing RCRP, which can be applied more broadly than cases relating to mental health. When implementing RCRP under the NPA local areas were encouraged to work in collaboration to determine the most appropriate approach to implementation, with suitable timings to ensure seamless provision of care.

1.2 Supporting activities

To supplement the strategic approach set out in the NPA and force adoption of RCRP, the NPCC, CoP, DHSC and NHSE have produced detailed guidance to support local areas with the operational delivery of RCRP. The APCC has produced guidance for PCCs to support local oversight and scrutiny of RCRP. The guidance documents have been published at various times, as they were being developed, and some were published after this research had been conducted; for example, the CoP guidance relating to children. The absence of guidance at the time may be reflected in some comments from research participants, particularly relating to NHSE guidance and children.

1.2.1 Guidance

RCRP Toolkit (CoP, 2023a)

The CoP RCRP toolkit sets out what RCRP is, and its aims to ensure vulnerable people get the right support from the right service, whether they have mental health or other health or social care needs. The toolkit outlines the calls for service within the RCRP remit, with a focus on policies, which include:

concern for the welfare of a person, when reported by a member of the public or partner agency
people who have walked out of a healthcare setting before medical care, or treatment, has been completed
people who are AWOL from mental health services
medical incidents, where a member of the public requests police to attend, or where police are already present

This toolkit supports forces in England and Wales to decide the appropriateness of a police response to RCRP related calls and implement RCRP successfully and consistently, in partnership with health and social care agencies. The toolkit is based on legal advice.

The following guidance packages are included in the toolkit:

legal overview for RCRP
senior responsible officer role
implementation principles for incidents involving children (see below)
baselining and evaluation criteria
communications plan considerations
policy considerations
force control room implementation guidance
e-learning

Smarter practice - Humberside (CoP, 2023b)

Smarter practice about Humberside Police’s adoption of RCRP has been published on the CoP’s website. Smarter practice relates to an activity that has been tried in a force, and is subject to review by the CoP, the NPCC and HMICFRS. The practice is then written up to share with other forces and it will be considered suitable for further testing and review.

Children and young people guidance (CoP, 2024)

To strengthen the guidance that has already been provided it was agreed between the Association of Directors of Children’s Services (ADCS), Local Government Association, the NPCC, and CoP to produce a jointly agreed set of principles-based guidance to support police forces and partners in implementing RCRP in respect of children. These principles have been included within the existing RCRP toolkit and complement its other parts; they have also been published by the ADCS (ADCS, 2024).

The principles provide guidance for police and partners, now and in the future, as to the engagement and action necessary to ensure that the need to act in the best interests of the child is considered throughout RCRP and will ensure compatibility between RCRP, the Working Together to Safeguard Children statutory guidance and the Children Acts (DfE, 2023).

Guidance from NHSE

NHSE has shared useful resources for health systems to support delivery of the NPA: RCRP, including good practice examples and advice on implementation, via the Future NHS platform. In November 2024, NHSE published guidance to further support systems (NHSE, 2024b). The guidance covers multi-agency working, mental health-related concerns for welfare, cases where people with mental health needs leave hospital before treatment is complete or do not return from agreed leave, transportation of people with mental health needs and s136 handovers.

Guidance for local authorities’ adults’ social care staff

This guidance has been developed by DHSC and intends to support local multi-agency partners to work together to successfully implement RCRP as defined in the NPA. Primarily, it is intended to support social care professionals and partners in making, and participating in, local multi-agency partnership arrangements for NPA: RCRP in local areas as police forces move to implement an RCRP approach. However, it should also be of use to anyone involved in local NPA: RCRP implementation, including police forces, ICBs, ambulance services and acute services which deliver mental health care and support.

Guidance for police and crime commissioners (APCC, 2024)

APCC guidance, published in April 2024, aims to support police and crime commissioners (PCCs) to fulfil their statutory duties to hold chief constables to account and to work in partnership in relation to the RCRP approach and the NPA. The guidance includes case studies of PCC-led activities to oversee delivery of RCRP and advice on engaging with partners

1.2.2 NPCC national implementation team

The NPCC established an RCRP national implementation team in early 2023. It was created to collaborate with police forces and partners to make sure RCRP is rolled out effectively, is quality assured, and keeps communities and vulnerable people at the heart of delivery.

The team led on the development of the RCRP toolkit and associated national legal advice. It also provided other resources and support mechanisms, such as briefings, to help forces and partner agencies to embed RCRP. Regular engagement also takes place with partners at a national level to reinforce local level engagement.

A Tactical Delivery Board (TDB) including representatives from all forces was also established to make sure the principles of RCRP are consistently followed during rollout. This includes making sure delivery is completed to a high standard, with the support of partners, and is monitored and evaluated. At an early stage, the implementation team widened the TDB attendance to include both internal and external partners, such as FRS. This helped achieve transparency and allows concerns to be raised. This approach was replicated at a local level, with forces sharing learning and best practice with each other and seeking support when they encounter challenges. At the time of writing, the NPCC implementation team remains in place to collate information and to provide guidance and support for police forces and partners.

RCRP Oversight Group

The RCRP Oversight Group is currently organised and chaired by the NPCC, NHSE, DHSC and the HO. This is a forum that brings together those with clinical, operational and policy expertise to review and discuss concerns that have been reported in relation to implementing RCRP, record any risks to delivery or issues, and identify potential actions needed to address concerns, including any national level learning or action that will be taken forward.

1.3 Research activities

1.3.1 Aims

The aim of this evaluation is to understand whether RCRP is being implemented as planned and identify any barriers to implementation across forces and lessons learnt on the ground from policing and health partners. A process evaluation across policing and health and social care partners was essential to gather the evidence to support this aim (GOV.UK, 2020). The evaluation also includes analysis of quantitative police data to assess early indications of change in police time and perceptions of initial benefits and risks. This analysis contributes to the wider objective of testing whether RCRP is achieving the desired outcomes of better care and support for individuals from the right agencies, and a reduction in police demand.

For the evaluation on both the police and health and social care sides of RCRP, HO and DHSC analytical teams carried out separate research activities and analyses that were then brought together in the discussion (section 4).

1.3.2 HO research activities

The HO policing research questions included:

what worked well during the early implementation of the RCRP approach?
what have been the main issues/barriers with RCRP implementation?
what can be learnt from how RCRP was implemented?
has partnership working changed when dealing with RCRP categories compared to the period before RCRP was implemented?
has there been any changes in understanding of the appropriate health and social care provider to meet individual needs?
has there been any change in dealing with RCRP category calls?
has any change in RCRP category calls led to a saving in police time?

The HO research activities included a qualitative data gathering exercise from 3 police forces through interviews, observational visits, and surveys. It was essential for HO analysts to work with forces in the early stages of RCRP implementation to gather evidence needed to support our understanding of how RCRP is being delivered. The development of a theory of change model, engagement with stakeholders and an early evaluation scoping exercise allowed us to refine the objectives and structure of the process evaluation work.

A quantitative data collection exercise has also been conducted with a sample of police forces following their implementation of RCRP. HO analysts have worked closely with the NPCC national implementation team from the start of RCRP implementation to engage with forces to identify a set of metrics to support this evaluation.

Early engagement with stakeholders identified fire and rescue services (FRS) as potentially being impacted by the implementation of RCRP. To gain a better understanding of RCRP implementation from the perspective of FRS, interviews were conducted with area managers from the same 3 police force areas being studied.

1.3.3 DHSC research activities

The DHSC research questions included:

how have health and social care begun implementing changes to delivery as a result of RCRP?
what barriers and facilitators to implementing this intervention have been identified?
has partnership working changed as a result of implementing RCRP?
what unintended consequences or risks have been identified?

DHSC research activities included surveys with ICBs and LAs. Between June 2023 and March 2024, 3 implementation surveys were conducted. ICBs were invited to respond to all 3 surveys, and LAs were invited to respond to the last 2 surveys. These surveys provide details about implementation plans and pace of rollout, partnership working and local governance, infrastructure needs and barriers, expected demand impacts and challenges to resolve. Besides being used for evaluation purposes, these surveys have informed ongoing policy work as well as national oversight arrangements.

Qualitative implementation case studies, consisting of interviews with frontline health, social care and VCFSE sector staff, were commissioned via the call-off analytical facility (CAF) which is delivered by a team of independent researchers from the University of York and the King’s Fund (Jefferson, et al., 2024). The CAF is funded by the National Institute for Health and Care Research Policy Research Programme and is designed to enable DHSC analysts and policymakers access to small-scale, fast turnaround, policy relevant research. The academics are independent from DHSC and will publish their full findings in a report through the University of York, alongside this evaluation report (Jefferson, et al., 2024).

Question 3

2.  Methodology

Accepted Answer

2.1 Outline of research sample

The HO selected a sample of areas for evaluation and monitoring based on the following criteria:

the force’s regional area, population density in the police force area (urban/rural), and police officer workforce in their area (HO, 2024b)
the regional health area corresponding with the police area, the percentage of acute hospitals meeting the ‘core 24’ service standard (a liaison mental health service model that is provided 24 hours, 7 days a week, commonly provided across urgent and emergency care pathways), the percentage of mental health teams that are open 24/7, and total staffing reported via the mental health liaison survey (NHSE, 2023)
the force’s RCRP implementation date was an important criterion - all areas included in the evaluation were required to have implemented at least one phase of RCRP to be eligible for inclusion, and for data monitoring at least 3 months of data post implementation were required

The police forces included in the HO process evaluation were pseudo-anonymised for confidentiality of the research participants; they were from these areas:

north of England (one medium and one large-sized police force)
east of England (one small police force)

Police forces included for data monitoring were made aware that they would be named in this report; these police forces were:

Essex Police
Metropolitan Police Service (MPS)
Northamptonshire Police
South Yorkshire Police
Thames Valley Police

The implementation surveys issued by DHSC were sent to all ICBs (in June 2023, October 2023, March 2024) and all LAs (in October 2023 and March 2024) in England. For dissemination, DHSC analysts relied on NHSE regional leads to share the survey with their local ICBs, as well as partners in local government, including the Ministry of Housing, Communities and Local Government (formerly the Department for Levelling Up, Housing and Communities) and social care.

Surveys were shared with all ICBs and LAs regardless of whether they had started implementing a phase of RCRP or not at the time. Due to this, the DHSC survey findings are from a wider selection of areas than the research conducted by the HO and the health case studies conducted by the academics, which focused on areas where RCRP implementation had begun. Caution should be taken in making direct comparisons between the DHSC surveys, health case studies and HO research. However, findings are synthesised to create a cohesive understanding of the overall relationship between the 2 areas.

The DHSC-commissioned implementation case studies, conducted by the CAF, were set up to align, where possible, with areas covered by the HO evaluation and monitoring. Research was conducted between December 2023 and March 2024 and covered the following regions:

north of England
midlands
south of England

2.2 Process evaluation

2.2.1 HO methodology

The 3 police forces selected to take part in the process evaluation were each evaluated using the same methods. HO analysts conducted the research to obtain in-depth thoughts and a range of views across police officers of different ranks and police staff. A participant information notice was provided to all participants prior to the research being conducted, any questions were clarified, and informed consent was obtained prior to any data being collected. Participants were informed that the research was being conducted to understand best practices and where there may be barriers to implementation of RCRP, and to learn from knowledge they had gained through their experience of RCRP implementation within their force. All qualitative data collected through these methods and any quotations used in this report were pseudonymised to protect the identity of the participants.

The research comprised several elements; these were:

9 semi-structured interviews with the police force implementation leads and senior officers responsible for implementation of RCRP and the PCC for each of the force areas
observational visits to the 3 police force control rooms to observe call handlers and dispatchers (during the observations, 30 operators were asked questions and observed, and 15 additional structured interviews were conducted with operational and control room staff who were available during the visits)
an online survey conducted with control room and operational staff from each police force (221 responses were received, of which 127 provided sufficient information for analysis - of the 127 responses, 72 respondents were from enquiry office and force contact or control rooms and 55 were from other staff including custody, investigation, multi-agency safeguarding hubs (MASH), neighbourhood and response, project support, and street triage)
3 semi-structured interviews with FRS aligned to the 3 police force areas, to understand their response to the implementation of RCRP

Semi-structured interviews

Interviewees were identified through consultation with the NPCC and forces and followed the same selection process as the early evaluation work. The interviews were semi-structured and followed a topic guide that focused on questions relating to legal responsibilities, partnership working, the impact of RCRP, training and data collection (see annex A). All interviews were conducted online using the Microsoft Teams application by one researcher, with a second researcher taking notes during the interview. The audio, visual and transcript elements for the interviews were recorded on Teams and saved according to data protection arrangements. Transcripts were checked for accuracy and anonymised.

Observational visits

An observational topic guide with questions was created for the force visits. On the visits, researchers conducted observations, listened in to calls, and asked questions to call handlers and dispatch staff who were available. Care was taken to ensure participants were not distracted by the researchers and priority was given to their operational duties, with research activities taking place flexibly around their work. The observational topic guide was followed by the researchers and notes were made on the topic guide (see annex B). Observations for each participant took around 45 to 60 minutes - this varied depending on the type and number of calls being received and operational considerations.

Short, structured interviews that took 20 to 40 minutes were also conducted with staff who were available on the day of the force visit. There was a structured interview topic guide that researchers followed, and participants’ responses were recorded for analysis (see annex C).

Online survey

An online survey was included in the HO process evaluation to obtain additional views regarding implementation of the RCRP approach. Like the interview and observation topic guides, questions for the survey included sections on working with partner agencies, training, the perceived impact of RCRP and data collection. During the observational visits to police forces, the survey was promoted to operational and control room staff. The survey was opened to respondents on the day of the visit and remained available for responses for one week. The survey contained closed questions for quantitative analysis, and open questions for qualitative analysis.

Coding and analysis

The semi-structured interviews, structured interviews, observations, and survey open questions were coded by researchers using template analysis (Brooks & King, 2014). This method of analysis allowed a pre-determined template of themes to be formulated that included the topic guide themes of knowledge, engagement, implementation, legal responsibilities, impact, training, and data collection. The method emphasises structured analysis along with flexibility to adapt themes through the coding and analysis. Textual data from the interviews and observations was highlighted and coded if it was identified as relevant and potentially contributing to understanding of the research questions. The interview and observation codes, along with extracts, were reviewed, grouped and added to the coding template as codes were identified through analysis of the data. This coding method is the same process used in most thematic approaches. Co-coding was used to quality assure the analysis; if there was a disagreement between coders, the extract was discussed, and codes agreed.

Fire research and analysis

To gain a better understanding of RCRP implementation from the perspective of FRSs, 3 FRS leads were interviewed. These leads were based in the same 3 policing areas as the police evaluation and monitoring research where the police had either implemented or were in the process of implementing RCRP. Interviews took place with an area manager within each service who was responsible for co-ordinating implementation, including rollout and engagement with stakeholders.

Interviews were recorded, transcribed, and thematically coded using the process described above to identify key topics, themes, and subthemes.

2.2.2 DHSC methodology

Implementation surveys

The implementation surveys were developed by DHSC with input from NHSE and were focused on the implementation of the RCRP approach for mental health and wider health and social care incidents. The surveys were hosted online via Microsoft Forms on DHSC’s secure server. This method allowed participants from various organisations to respond while keeping the results visible only to the DHSC analysis team. The invitation to participate in all the surveys was disseminated via NHSE’s regional mental health leads to representatives from health services in ICBs. Representatives from LAs and social care services in LAs were invited to participate via newsletters and bulletins hosted by the Department for Levelling Up, Housing and Communities (DLUHC), the Local Government Association (LGA), and the Association of Directors of Adult Social Services (ADASS). All surveys consisted of open (free text) and closed (single or multiple-choice) questions. Findings from the early survey’s open questions informed the design of closed questions in subsequent surveys. Each of the implementation surveys was open for responses for 4 weeks. Closed questions were analysed quantitatively using Microsoft Excel and the statistical software R. Open questions were analysed qualitatively, using thematic analysis with an iteratively developed codebook. Co-coding was used to quality assure the analysis; if there was a disagreement between coders, the extract was discussed, and codes agreed. All data collected and any quotations used in this report were anonymised to protect the identity of the participants. Therefore, no information, such as job role, is provided alongside quotations to distinguish between participants. To comply with all relevant data protection and privacy regulations, participants were informed about how their data was used and could withdraw participation at any point, and their data was stored securely in area to which only relevant researchers had access.

In this report we include findings from the first survey of ICBs in June 2023 to which 38 ICBs responded (90% response rate) and findings from the third survey of ICBs which was accompanied by a survey of LAs to which 35 ICBs (83% response rate) and 39 LAs (25% response rate) responded. The second survey, from autumn 2023, is not explicitly included in this report as its design was targeted at informing ongoing policy development rather than evaluating implementation progress. Themes from the second survey were used to inform the third survey, which provides the most up-to-date picture on implementation from a health and social care perspective.

Implementation case studies

Qualitative research using semi-structured interview guides was conducted by independent academics from the University of York and the King’s Fund, commissioned by DHSC. Interviews lasted about one hour, were conducted via telecommunication software and then transcribed. Interviews were conducted with a range of frontline staff, including mental health service leads, AMHPs, social care service leads, liaison psychiatry leads, ED leads, ambulance trust senior managers, and staff from the VCFSE sector. Interviewees were identified with the help of DHSC and NHSE colleagues and referrals through regional networks of contacts and stakeholders. Three of the researched locations had fully adopted RCRP, and 3 had partially adopted RCRP, at the time of the research. Analysis was conducted iteratively following a thematic analysis approach according to Framework Analysis principles (Ritchie & Spencer, 1994). As well as the summarised findings from the University of York’s research being included throughout the healthcare findings section of this report, the full findings will also be published by the University of York’s researchers alongside this evaluation report.

2.3 Police data monitoring

The primary objective of this analysis was to provide insight into any early indication of changes to the number of calls about incidents related to RCRP the forces receive; officer deployment to these incidents; and officer time saved, following the implementation of RCRP. Given the relatively short period for which post-implementation data was available, our objective was not to definitively ascertain impact but rather to identify early trends that may be indicative of potential effects.

Data monitoring utilised incident data compiled by 5 police forces selected to participate. Incidents are generally reported through the emergency (999) and non-emergency (101) telephone lines, although, for some forces, the incidents recorded may also include contact made through alternative channels such as email or online forms. Police forces record the reporting of these incidents routinely and systematically, following strict rules on what is collected and how it should be recorded and managed.

Prior to collecting incident data from forces, a baselining metrics mapping exercise was conducted which involved engagement with each of the English police forces to establish which metrics forces are able, or plan, to collect to monitor and baseline RCRP implementation. Following this exercise, a data template was created, informed by the responses to this exercise as well as CoP baselining and evaluation guidance (CoP, 2023c). The variables in the data template included, but were not limited to:

opening and closing incident type (the category assigned to an incident based on its circumstances) - for many police forces, incident types are applied when details of an incident are first recorded on the force system (opening category), as well as when the incident is resolved (closing category), the opening and closing incident types may differ as further information is gained during the incident
number of officers attended
time/date incident opened, deployed to and closed
flags or qualifiers (additional markers or indicators that are applied to recorded incidents to provide classification of the incident type, such as specific risk factors, vulnerabilities, or special circumstances), for example, ‘alcohol’ may be applied to a crime incident to provide further information about the incident

For most forces, all of these variables were recorded for each individual incident as part of their routine operations. However, forces collect and record the information differently and, in some cases, did not collect all of the variables requested. Therefore, forces were encouraged to use the template as a guide and provide data in the format that was most appropriate for them.

Incident data was requested for the 12 months prior to the first part of the force’s implementation of RCRP (which was most often phase 1 of RCRP ‘concern for welfare’) and any data generated between implementation and the date of request. Data was requested up to 31 January 2024.

Data collection process

Analysts within each police force compiled the incident data as requested and transferred this securely to HO researchers. A data sharing agreement was established prior to this, ensuring compliance with all relevant data protection and privacy regulations. In adherence to this agreement, and to protect the privacy of individuals, incident data was anonymised and provided with abstract identification numbers. Where location data was provided, this was only given at a level high enough for individual incidents not to be identifiable, such as LA areas.

Data checks and cleaning

Upon receipt of the incident data from forces, researchers conducted a rigorous cleaning and checking process to ensure the accuracy of the data. This process involved checking the completeness of variables and looking at trends in variables over time to highlight any anomalies or outliers. Checks on variables containing dates and times were conducted to ensure data was all contained to the requested date range and variables had been recorded in a logical and chronological order. Any concerns or inconsistencies raised during this process were discussed with analysts in each force to identify any errors and agree the best approach to handling the data. Depending on guidance from each force, incidents containing errors were either excluded from analysis, or excluded from any analyses where the variables that contained errors were included.

Analysis focused on the ‘concern for welfare’ phase of RCRP. For most of the forces within the sample (3 forces) this was the only phase that had been implemented when data was collected while the other forces implemented all phases at the same time (2 forces). The additional phases have not been excluded, but they may not associate with the measures used in analysis as directly as the ‘concern for welfare’ phase. This phase was deemed to be associated with the most accurate and reliable data and was recorded consistently across forces, which enabled more reliable analysis. Variations in implementation timings between forces mean it is important not to compare forces with one another.

Each of the forces in the sample categorised incidents as ‘concern for safety’, using the incident type applied when incidents were opened and/or closed. Where possible, incidents were considered ‘concern for safety’ if this category was applied when the incident was opened, as this would be the point at which deployment decisions are made. However, in forces where ‘concern for safety’ could only be applied at the closure of an incident, then this categorisation was used. Generally, ‘concern for safety’ refers to any situation where there is risk or threat to someone’s safety. This could include circumstances where individuals are in danger due to others’ actions or due to their own actions. It may also encompass incidents involving checks to establish a person’s whereabouts, who is absent from a place that they should be, or are expected to be, but who is not considered to be a ’missing person’, or welfare checks. These incidents have been identified as those most likely associated with the implementation of the ‘concern for welfare’ phase of RCRP.

Flags and qualifiers refer to additional categories that can be applied to incidents. These are designed to capture more information and the characteristics of an incident. The use of qualifiers supports forces in understanding their demand and providing the right resource to specific types of incidents. Analyses were conducted to explore the number of incidents with a mental health qualifier applied for forces that collected this information. Each force in the sample had a different set of qualifiers. For some, there was a singular qualifier specifically relating to ‘mental health’ more generally. For others, there were several qualifiers which researchers deemed relevant to mental health, such as ‘suicide and self-harm’ and ‘use of s136’. In these cases, incidents were included in the analysis if they had at least one of the relevant qualifiers applied. The mental health-related qualifiers included in each analysis are listed within the findings section for each force.

Analysis

The key approach to this analysis was to compare incident data a year pre-implementation to data post-RCRP implementation. This approach provided a baseline understanding of calls and deployments in a typical year and then allowed for accurate month-on-month comparisons that mitigate seasonal variances. The software platform R was used to conduct data checks, cleaning, and descriptive analysis. Data checks and cleaning were undertaken before conducting the descriptive analysis and producing graphs for each force. In addition to analysis of ‘concern for safety’ incidents, analysis was also conducted on incidents with a mental health qualifier applied.

Estimations of the amount of police time saved following implementation of RCRP were also calculated. These estimations used the following calculation (further detail in annex D):

(Average incident time x reduction in the number of incidents attended) x median officers deployed = time saved.

Limitations of analysis

There are several limitations that are important to consider when interpreting the analyses included within this report.

Incident data is not recorded for research purposes and is open to human and system errors. Human error is possible for any of the variables that are entered manually. These include the incident categories and qualifiers which are applied by call handlers. The time and date of incidents being attended and closed is dependent on officers logging this information. System errors can occur on any data recording system; for example, from software bugs, hardware malfunctions or integration issues between different systems. Data cleaning and discussions with forces to ascertain the most appropriate way to handle their data took place to mitigate these errors wherever possible.

Force incident recording systems differ, and each force identified a different approach to determining whether an incident was deployed to or attended by officers. Analysts utilised variables advised by each force to determine this. However, there may be instances where an incident appears to have been deployed to, but officers decided not to attend. This may happen in cases where, following officers being dispatched, updated information is received indicating the incident has been resolved before officers were able to attend. There may also be incidents which do not appear to have been deployed to, but officers attended as they came across the incident without being deployed. We have used the terms ‘deployed’ and ‘not deployed’ within our analysis but this may not always be accurate in the cases described.

For consistency of approach to calculations, the time taken to deal with an incident was taken as opening to closing time. The data was captured by all forces in our sample. This measure includes travel time, however, in some cases staff will not be providing any input to the incident; for example, if the incident has been dealt with but the officer is not available to provide details for final closure. The median deal time was calculated to account for incidents with very long, or short, deal times. The ‘deal time’ calculation will vary if a different measure is used; for example, the time of arrival at an incident to the time a patrol departs the incident. There are strengths and weaknesses for different measures, but the analysis included in this report aimed to apply a consistent and reliable approach.

In some cases, modifications were made by forces to their incident recording systems, and approaches to incident recording, to better monitor and collect data on RCRP. In these cases, there are limitations to comparing data that was collected prior to these changes and after they were made as this may have introduced inconsistencies in how the data was collected and recorded. Where this is relevant to a force, this has been highlighted in the findings discussed.

In terms of interpretation more generally, it is important to note that any trends noted after implementation cannot be solely attributed to RCRP. There are many uncontrollable external factors that impact policing and police time. Therefore, findings must be interpreted with care.

Question 4

3.  Findings

Accepted Answer

Research findings from the HO and DHSC are presented separately below (sections 3.1, 3.2, and 3.3) as the HO and DHSC strands of the research were conducted independently of each other. Without conducting additional research and analysis, it would be difficult to directly match views of partners from different areas with specific comments and findings from this research. Findings from this research have been synthesised in the discussion (section 4).

3.1 Police

3.1.1 HO process evaluation findings

The findings reported here include insights from police officers and police staff and are a combination of analysis from:

semi-structured interviews with senior police officers leading on implementation of RCRP in their force and PCCs - to avoid the identification of individuals, and for the purpose of this report, these participants are collectively referred to as ‘policing leads’
observations and interviews conducted during the force visits with operational police officers and operational police staff, both control room and non-control staff - to distinguish these policing staff from senior police officers and PCCs, they are collectively referred to as ‘operational police staff’ in the report
survey responses from contact and control room staff and other police staff who responded to the survey questions, not all respondents answered each question (see annex E for details of responses to the survey questions included in this report)

Key findings relating to each theme from the interviews, observations and survey responses are included in the report. The themes are knowledge of RCRP and police legal responsibilities, partnership working, application of the RCRP approach, impacts of RCRP, training and data collection.

The findings presented reflect qualitative perceptions and experiences of participants involved in the research. Quotes and extracts from their interviews are included to illustrate participants’ views and provide early insights of perceived impacts. It is important to note that these are not quantitatively measured impacts. Checking the veracity of incidents and examples cited by participants was not within the scope of this research. While it is out of scope for this evaluation to investigate individual concerns, areas should have escalation processes set up locally that can review cases and identify any changes in practice required to respond to similar situations in the future.

3.1.2 Knowledge of RCRP and police legal responsibilities

Knowledge

Findings highlighted good understanding from forces of the RCRP approach and its aims. Participants recognised the knowledge that would be required by control room staff and frontline officers to deal with mental health and RCRP related incidents. Findings also showed the benefits of having access to the knowledge of Humberside Police and its legal department when implementing RCRP.

Operational police staff mentioned that knowledge of the purpose and aims of RCRP was needed to identify the right partner to deal with an incident. This was to ensure the public is receiving the right care and may result in a reduction in police demand so they can focus on other policing duties. Researchers observed that call handlers were able to identify incidents related to RCRP, ask questions, use toolkits, and that they understood their responsibilities. Policing leads added that police officers were not adequately trained to deal with mental health, and that time and resources were being spent at mental health incidents unnecessarily. They added it had been helpful to follow the Humberside approach to implementing RCRP; for example, the Humberside legal advice was checked and amended as necessary for their force.

Police duty of care and safeguarding

Policing leads and operational police staff were aware of their duty of care and safeguarding responsibilities, and the threshold for making decisions to deploy. Participants were alert to Articles 2 and 3 of the European Convention on Human Rights (ECHR) and the duty of care for safeguarding when they accept an incident for deployment. Specifically, they noted that the police have a duty of care where there is an immediate threat or risk to life and for people in need of care. A duty of care was also recognised for those who are detained in custody needing to be admitted to hospital under sections 2 or 3 of the MHA, but no hospital beds were available. Policing leads and operational staff highlighted their additional duty of care to safeguard children. It was mentioned that the police deal with incidents that should be dealt with by other partners, which may be due to partners’ lack of resourcing capacity or knowledge of their responsibilities. It was identified that the police will accept responsibility if a crime were being committed and to keep the peace.

“We can’t just abandon people who are in need, (…) we will never abandon people who are in need for a place of safety or to be made safe, and that’s an important message.”

Policing lead, PE7

“We recognise our obligations around children as being a particularly vulnerable category, so we insert that as our first question.”

Policing lead, PE8

Operational staff added that police were still spending a significant amount of time attending s136 incidents; for example, in EDs when hospital staff are present who, on some occasions, could keep the patient safe. However, they also added that RCRP had helped partners’ understanding of their duty of care.

Police powers and response

Policing leads and operational police staff commented that section 17 (Police and Criminal Evidence Act, 1984, section 17 1e) was used to gain entry to properties to save life and limb, and legal powers of entry are devolved from s135 MHA warrants. These powers need to be carefully considered when entering properties for RCRP related incidents, such as concern for safety, and ensuring the police have a power of entry, with or without a warrant. Participants clarified that the police will still attend RCRP related incidents where required when the threshold for responding has been met. When responsibility for an incident is accepted by a call handler, and an indication of police action is given, staff recognised their responsibility to respond. They also acknowledged police responsibilities for the welfare and rights of the individuals but added that better support may be provided by other partner agencies.

“If there is an emergency [for example, someone in mental health crisis] and no one else is available, the police will always respond. If there is a crime being committed, the police will always respond - that is not negotiable.”

Policing lead, PE5

“We recognised that once we accepted responsibility for any of those incidents and certainly once we attended any of those incidents. We took on full legal responsibility for the welfare and rights of those that we were interacting with.”

Policing lead, PE4

Operational staff noted that RCRP provides a framework for the response to calls and it supports their decision to decline attendance when there is no requirement for the police to respond. They were aware of which partners to contact and would pass information to others. Researchers observed operational staff and noted what they believed to be was a clear knowledge of police requirements to respond. This was evident through the use of toolkits, which included police legal responsibility related to RCRP and the grading of RCRP incidents. It became apparent that staff were able to identify incidents they should or should not be deploying to under RCRP by using the toolkits and asking, what the researchers observed to be, the right questions on the call.

Police decision making

Findings highlighted that RCRP toolkit and legal advice had been useful in supporting understanding and improving decision making for the implementation of RCRP. Policing leads recognised the thresholds for making decisions were based on their existing legal duties, as set out in the RCRP toolkit. They understood calls come to control rooms for decisions, so those staff need to understand where the threshold lies. It was noted that following a review of existing police legal responsibilities, their legal position was made clearer. This supported understanding and would improve decision making for control room staff. They added that operational staff will work through incidents to make decisions based on the threshold for police involvement while considering any risks and vulnerabilities.

Policing leads recognised that sharing information and knowledge helped inform their decision making; for example, by explaining police deployment thresholds to partners. They said their knowledge about decisions and the application of thresholds were informed through advice from legal teams and coroners when they examined the decision making for police attendance in specific cases. It was understood that officers and organisations could be liable for decisions made if there was a legal responsibility to an individual that was not acted upon.

“For us the issue has been that legal threshold. (…) So, it’s been really helpful with the partners to go through scenarios because our understanding of real and immediate threat to life is very, very different to theirs.”

Policing lead, PE9

3.1.3 Partnership working

Partners’ knowledge and legal responsibilities

The findings identified the importance of partnership working in improving understanding of RCRP and partner legal responsibilities. Policing leads recognised that their discussions with partners were guided by a focus on their legal responsibilities and this collaborative approach enhanced their understanding of each organisation’s legal position. It was noted, when developing their RCRP approach, that the police’s responsibilities often fitted within their existing statutory and general partnership working arrangements. This included, for example, under the MHA where there is the need for the police’s power of arrest, they will use their powers under section 18 MHA for absentees from mental health facilities. Policing leads identified some differences in perceptions of each other’s responsibilities when working with partners, including of the exercise of police powers. They recognised that partners’ understanding of the correct use of police, ambulance and FRS powers of entry was important. It was noted that the police have always been able to say they will not deploy to incidents, and RCRP provided a means of increasing partner understanding of the police role and their decisions.

Engagement with partners

Engagement with partners was viewed as essential when implementing RCRP. Policing leads identified a need for partners to work together strategically and at different levels to understand how each other deals with cases related to RCRP. Participants stated that this was achieved through engagement and the setting up of oversight groups with ICBs and other multi-agency groups, and at meetings and workshops. It was noted that when partners were kept informed about RCRP, they were able to share concerns and feed into RCRP decisions. Policing leads reported that they had listened to partners’ initial concerns about implementation dates for RCRP, which were addressed, and implementation delayed to a date when partners felt comfortable.

“At each level [we] have built the opportunity for discussion, sharing of information, so senior operational and then operational levels too. And one of the things that was very important was the workshops that were run prior to go live. That allowed people to really share their biggest concerns, allowed them to be recognised and allowed agencies to start thinking about what they would do.”

Policing lead, PE4

“(….) initially we were going to roll it [RCRP] out about September last year and taking on board the views of partners, we delayed that process and again it was delayed into the New Year because of the winter pressures on social care, the ambulance service etcetera. (…) we’ve actually listened to partners and partners, expressed some concerns (….).”

Policing lead, PE7

Policing leads also recognised that being transparent through strategic and tactical groups helped mitigate any tensions with partners and enabled reflection on systems and processes. Operational police staff noted that when there was less engagement, there had been some friction and less support from partners. They noted some initial pushback from partners when RCRP was starting to be adopted and thought this may have been due to a lack of understanding. But, when engaging at a tactical (operational) level, concerns could be raised and partners’ capacity to deal with incidents discussed.

Policing leads and operational police staff acknowledged safeguarding was considered when engaging with partners, including when working with NHS staff in their police force areas, social services and with schools, in the MASH process and when completing digital referrals. Policing leads recognised their good relationships with children and adult safeguarding teams, who had some initial reservations, but concerns had been worked through. It was acknowledged that resourcing for children’s and mental health services was an issue for partners.

Policing leads identified several positive points when engaging and working with partners. They said that early engagement with ICBs, NHS foundation trusts, NHS acute trusts and NHS mental health and specialist trusts had enabled better structures for partnership working. They added that senior management support and positive engagement with other partners, including FRS, ambulance, PCCs, and VCFSE organisations, was important to develop governance structures. It was also recognised that PCC engagement with partners was important. Partners can, if needed, engage with their PCC about the RCRP approach being taken in their area. Policing leads added that the scope of RCRP and the NPA were discussed with adult safeguarding teams, and police reinforced to them that RCRP was wider than mental health.

“We also set up 5 areas of development, which were requested by the partners. So those meetings were urgent care, children’s safeguarding, mental health, adult safeguarding, and the voluntary sector. So, in total 18 meetings for those working groups alone, so 50 hours of engagement on top of all our TCGs [tactical coordination group] all our SCGs [strategic coordination groups] and all our DCIs [detective chief inspectors] linked to all our safeguarding boards outside. That is what we’ve done across partners, which is a considerable investment.”

Policing lead, PE9

Operational police staff identified there had also been positive engagements and good rapport with care home staff, health professionals, ambulance staff, and when working with the FRS. Good working arrangements were identified with mental health services, crisis teams and mental health triage teams. A survey respondent noted that being open and transparent ‘has really helped to transform relationships and increase positive relations.’

Policing leads also identified some challenges when engaging with partners. They raised concerns about social care, with some LAs and social services who, despite having initial concerns, were not engaging or attending meetings. Policing leads also noted there was limited GP engagement, with some GPs viewing RCRP as not relevant for them and not attending meetings. It was mentioned that it would be helpful for GPs to be involved in talks and meeting with their local police force to see how RCRP may introduce change for them or to raise any concerns around their gaps in services. Another respondent mentioned how, through RCRP, closer work between the police, GPs and coroners may help the coroner’s system. It was noted that GPs would also gain from having an awareness of when to ring the police in relation to RCRP. An example was given of one GP who had called the police regarding a patient expressing suicidal ideation. They were advised to attend an ED, but when the GP found out the patient had not attended, the GP called the police for a welfare check to be conducted.

“(…) We’ve had a bit of a challenge and then some pushback is from the GPs (…)it was always going to be challenging, you can bring certain people to those forums and discuss, (..)give them the opportunity to go back to their own organisations and networks to understand what that means for them in terms of any change and to then raise any concerns around gaps in service. (…) perhaps hasn’t worked so well in terms of the GPs. But of course, when you’ve got 30 more nearly up to 40 practices all individually run, that was always going to be a challenge.”

Policing lead, PE1

Application of the RCRP approach with partners

Policing leads highlighted how RCRP was being applied in practice with partners. It was evident there was an understanding of the health and social care context, including the limited mental health bed capacity, and the sustained pressure on EDs in England, and how this affected the application of RCRP. Resourcing was also recognised as difficult by police operational staff when handing over s136 patients.

“The greatest challenge is resource in health (…) we’ve got to be realistic in that we can’t magic mental health beds that don’t exist. (…) It’s probably a wider funding resourcing capacity issue (…).”

Policing lead, PE1

“We wanted to be sure that if the police were going to step back from some of these roles, that had been added to their duties over time, that we’re not just going to leave them in the lurch but those partners who were expected to pick things up would do so.”

Policing lead, PE6

Policing leads outlined that reviews of incident decision making were taking place at strategic and tactical levels with partners to ensure RCRP was implemented correctly. They were cognisant of the NPA and reflected on how it was helping the police understand their responsibilities, such as protecting vulnerable people and treating people fairly. For one force, it was noted that, in their view, implementation of RCRP had not changed the thresholds for response that already existed where incidents involved children. Children were viewed as ‘vulnerable’ so the response would reflect their vulnerability, this would be the same before and after implementation of RCRP. Children’s services had acknowledged the police were fulfilling their statutory Working Together obligations, which is guidance on multi-agency working to help, protect and promote the welfare of children (DfE, 2023).

“I think children’s services, who were the most nervous when this went live, have actually realised that for children probably the thresholds have not really changed. And that we, under Working Together are still fulfilling our statutory obligations.”

Policing lead, PE9

Good practice in application of RCRP was identified, such as reviewing calls and escalation by control room supervisors if the response decision was not agreed with the caller or partner. Policing leads added that information and details were obtained following reviews of incidents, with examples of best practices. These were taken to partners through multi-agency networks and safeguarding meetings.

Challenges that policing leads faced when implementing RCRP included issues with the ambulance service on how they prioritise calls from the police relating to RCRP when their boundaries cover more than one police force area, and with the diversion of calls to the ambulance service on 111 or 999 to ensure ambulance attendance. These were issues which participants felt could best be resolved by dealing directly with their local ambulance service. One respondent added they had some concerns over preparation for the implementation of the later phases of RCRP, particularly for some ambulance trusts and mental health services, as this respondent was aware that commissioning of services can take time.

Operational staff also reported some concerns in the consistent application of RCRP with partners. They reported they had experienced difficulties with the ambulance service, including when determining attendance requirements where people are expressing suicidal ideation but are not at immediate risk of harm. Operational staff reported reservations when applying RCRP if ambulance services are not able to attend to someone who may need help. In response to a question during observations, one participant said they,

“Wrestle with [their] moral obligation as to whether to go but guidance says they shouldn’t.”

Operational staff, HS03

Operational staff also noted that a change of partners’ mindset was needed, adding that RCRP needs to be applied consistently for it to be accepted by partners, but that there were differences in how partners view risk; for example, the police use of definitions under articles 2 and 3 of the ECHR and their assessment of risk using the National Decision Making (NDM) and threat, harm, risk, investigation, vulnerability, engagement (THRIVE). They also reported that since implementation, partner agencies (social services and schools) still contact the police to report incidents when they are going off duty.

“Friday afternoon gets lots of calls as schools finish and social services go home so report it to police as don’t want that risk on them - with time all agencies need to understand and then start to make own changes.”

Operational staff, HS01

Policing leads recognised various learning points when they applied RCRP. They said a joint collaborative approach had worked well. This collaboration approach had helped partners’ understanding of where there may be gaps in service and how RCRP phases were being implemented. They highlighted that lessons could be learnt from VCFSE organisations in how they manage client contact, which may be helpful for police and partners. A further lesson learnt was that passing RCRP guidance; for example, on how to access mental health services, to other partners they do not routinely collaborate with, such as the Department for Work and Pensions (DWP) can help partners’ understanding of policing responsibilities. They noted that learning was achieved through information that was published, and from statistics that were shared with partners, showing changes following RCRP implementation. Operational staff also noted that RCRP was returning the duty of care to hospitals, rather than it being with the police; hospitals are conducting more of their own checks before calling the police for walkouts from hospitals, but further work needs to build on this.

Operational police staff reported positive aspects of the application of RCRP, including local agreements for the FRS to take on responsibility for some incidents, but it was also noted that the local FRS had on occasion been unable to assist the ambulance service gain entry. It was noted that having a direct telephone number for supervisors in FRS and the ambulance service worked better for supervisors in the police control room, as there had previously been difficulties in making contact. They said that partnership working had improved as roles are understood better within the RCRP approach. By way of illustration, a call from a partner was observed by researchers; the incident was not for police deployment, but the operator took time to support the caller and consider the best approach to deal with the incident.

Impact of RCRP when working with partners

Policing leads and operational police staff recognised that the biggest barrier to RCRP was partners’ willingness or availability to accept the duty of care, and that despite any capacity constraints, they should not simply call the police if it is not a police matter.

Policing leads noted a positive impact for handovers to mental health care, which police are trying to do in a more dignified way when detaining people under s136, such as using mental health response vehicles rather than police cars. They also noted working with organisations from the VCFSE sector that provide ‘safe spaces’, having set up safe spaces in the area, the organisations will have a direct contact pathway to police.

One policing lead added that incidents were raised by partners if they had a concern, and in their force only 6 incidents had been escalated in the first month since implementation, which they viewed as positive. Operational staff also reported positive impacts of RCRP, including a reduction in the number of calls relating to people who have walked out of hospitals. One policing lead noted that PCCs may be commissioning fewer services for the police as partners are delivering some additional services. One policing lead also noted that since implementation of RCRP ambulance response had improved when the police were with someone expressing suicidal ideation. Another noted improvement with returning the care of patients to hospitals after they had been reported absent. They commented that LAs were finding resolutions and the correct support for people, and there had been less reliance on the police. Other comments by operational police staff included that RCRP had given confidence to the police to challenge partners and hold them to account to accept risk that should legally be theirs; and that RCRP had brought partners closer together, making each aware of the issues the others face. An example of good practice was given where patrols were deployed to a 999 call from a person expressing suicidal ideation. A mental health nurse on patrol checked the person’s history and found there were previous mental health concerns for the individual. Patrols, supported by the police helicopter, could locate the person and provide the ambulance service with the location of the person so they could be given assistance.

Policing leads also identified challenges which may impact on partnership working. For example, it was reported that in some cases, since implementation of RCRP, the public had been advised by partner agencies to call the police to get a quicker attendance time, but that this could impact the response and care for the individual. It was recognised that time was needed to continue communication and engagement to enhance partners’ understanding. It was also noted that some senior level managers within partner organisations may not be providing information to operational staff, which could affect application of RCRP on the ground.

Operational staff identified challenges that were specific to health and ambulance services. Several felt a lack of health resources could lead to some health partners requesting police attendance as they did not have the capacity to deal with the cases themselves. Examples were reported by participants who described their experiences and perceptions of some challenges they faced, these included:

police reported that partners were adapting the information provided to the police to include RCRP principles that will necessitate police involvement, such as changing their wording to report someone missing instead of a concern for safety
an example of adapting or not providing accurate information to the police was given where the ambulance service called the police and mentioned that a knife had been wielded at a care home, but on calling the informant back the police confirmed that a butter knife was being used for cooking, and no threats had been made to use it - the participant who shared this example felt the caller was not providing accurate information and was adapting the information to ensure police attendance
hospital staff calling the police because it is their policy and not because staff think the police are required; an example was given of staff calling the police when someone had walked out of hospital to have a cigarette but were still in sight of hospital staff
some disagreements between ambulance and police control rooms that necessitated supervisory intervention
ambulance staff sometimes requesting police assistance because of previous violent encounters with a patient when the patient is calm and there is no immediate risk of violence at the time - when there is a clear and immediate risk of violence, police say they will always attend but feel their presence may not be warranted, or helpful, if the patient is not violent
an example was also given where the ambulance service was waiting for police attendance before entering a property as there was an information marker for ‘knives’ at an address, but the information marker was 17 years old

Operational police staff reported continuing issues with handovers, in that until the MHA assessment starts following a s136, police are sometimes required to be there when handovers and/or health provision is insufficient or untimely. Some healthcare professionals ask for the presence of the police during the assessment for their safety or the patients’ safety, adding to the handover time. Survey responses showed that 54% of other staff said wait times/handover times to partners were no different, 12% said wait/handover times had decreased and 16% said handover times had increased. (Note: the police forces included in the survey continue to work with partners on the implementation of RCRP that addresses handover times, so a reduction in times would not necessarily be expected at this point.)

In response to survey open questions, 9 respondents also mentioned concerns they had with the ambulance service, including respondents who said the police were still being deployed to situations they felt the ambulance service should attend. One survey respondent also felt the ambulance service can adapt the information they provide, which supports the challenge reported by other police participants in this research. One operational staff participant noted that, as partners’ resources were stretched, they rely on the police, but the police have their own workload and resource demands to contend with.

3.1.4 Application of the RCRP approach

For the public

When referring to engagement with the public when applying RCRP, policing leads reported initial doubts on how much knowledge the public needed, and how they would be informed when applying phases of RCRP. Policing leads and operational staff identified public interest in RCRP following a Metropolitan Police announcement and subsequent media reports about policing and mental health. Policing leads reported that engagement with the media was undertaken to explain RCRP after the announcement.

Policing leads and operational police staff identified positive engagement with the public when applying RCRP, such as when the public call the police, staff can inform them about the RCRP approach. Reactions reported were recognised as positive from some members of the public, who said they understood and accepted why the police should not be attending some incidents. Policing leads suggested there had been no concerns raised by the public, but they were aware implementation was still in the early stages and this could change. A survey respondent added they did not think members of the public were aware of RCRP and education for them around partner agency responsibilities would be beneficial.

Policing leads also identified some challenges they faced; for example, that direct communication with the public would be difficult due to the different RCRP approaches and implementation timescales in different police forces. Policing leads and operational staff understood that the public’s first instinct is to call the police and their expectation is that the police will deal with anything, but this is not always right as the police’s focus should be on crime and protection. However, it was noted that if someone called, the police would assist and/or signpost to other partners for mental health care and advice.

Practices and processes of the RCRP approach

Policing leads spoke about the phased approach for RCRP, explaining that practices and processes were documented for each phase to help partners’ awareness of their responsibilities. They said that lessons learnt from each phase can provide confidence and reassurance to partners before moving to the next phase. It was noted that the mental health phase, relating to s136 of the Mental Health Act and voluntary mental health patients (phase 4 of the CoP guidance) was an ‘aspiration’ as partners were facing challenges, and the ‘concern for welfare’ phase was less contentious.

“The ability for [partners] to escalate in those staged approaches, really gives them opportunities to raise the things they’re worried about and the fact that we are then openly sharing the data around (…) how many [incidents] have been challenged and to what degree was that found, has provided them [partners] quite a degree of reassurance. (…) so (…) not too problematic because phase 1 is around the concerns for welfare is probably slightly less contentious than some of the later stages.”

Policing lead, PE4

One operational police staff participant added that phase 1 ‘concern for welfare’ decision-making may have been applied to phase 2 incidents, such as walkout from healthcare or AWOL from mental health establishments, before phase 2 had been implemented. Operational staff identified that phase 2 will be more straightforward for control room staff to implement, but the impact on EDs may be challenging.

Policing leads highlighted the helpfulness of the CoP RCRP toolkit that they adapted for their force. Operational staff said that when they follow the toolkit, calls could be triaged in or out, so operators do not need to remember information. It was noted that the force’s toolkits allow a consistent approach following broad principles for all staff whenever they make professional decisions. They added that there had been a more rigorous assessment of decisions since RCRP was being applied, and they were also more confident in the decisions being made around children. However, operational staff also identified that the force’s call handler toolkit may not be designed to collect sufficient information, could oversimplify situations, and may not allow for the consideration of the person’s previous history of contact with the police. Policing leads and operational staff added that police systems should be checked for information relating to the call, for example, previous reports of violence related to the person or address, when they receive calls from the public. Operational staff added that using THRIVE was important, and that they were comfortable using it to ask questions and establish any immediate threat to life or risk.

“[we’re] more rigorous in our assessment and risk assessment and more considered in our deployment and decisions.”

Policing lead, PE4

Policing leads and operational police staff highlighted that reviews of policies and practices for RCRP were ongoing and were discussed on a weekly basis at senior management team meetings, and there are frequent conversations at a senior level, with sergeants, inspectors and force incident managers also reviewing incidents in depth. They identified that legal advice had been reviewed around concern for welfare decision-making and how far the police need to check this if they are not attending a call. Useful information and learning from the VCFSE sector were also identified, including reviewing cases to understand how the VCFSE sector works, which helped inform practices around duty of care. They added that governance structures within their force enabled reviewing of incidents to ensure RCRP principles were being applied correctly and incident flags had been developed to help the review and audit of cases. Policing leads explained the importance of reviewing calls and quality assuring deployment decisions; they also highlighted the escalation process for any issues. Policing leads reported that a few cases had been referred to coroners and professional standard departments where adverse outcomes had been noted. (Note: An ‘adverse outcome’ here could relate to a death, harm, or other negative consequence. For the instances reported during the research interviews, it was not within the scope of the research to check the veracity of the cases mentioned.) Following consideration of these cases by coroners and professional standard departments (PSD), policing leads reported there were no adverse outcomes resulting from the police response decisions. Operational staff said a few cases had been flagged where call handlers could ask more questions, adding that, as cases are reviewed over time, call handlers’ confidence will build. They also noted that they often discuss with colleagues the best approach for RCRP calls.

Policing leads also said control room managers will audit and review:

incidents where an adverse outcome was suspected, to review if the correct RCRP enquires and decisions were made by the call handler, and report to PSD and coroners where required
calls created by staff outside control rooms, for example from professional standards departments
information that is passed to staff outside the contact centre, which is currently the focus for decision making
incidents once RCRP is operating as ‘business as usual’

Policing leads identified good practices and processes for the RCRP approach, including in planning for RCRP and having working groups with partners to develop processes prior to implementation; no issues of concern were raised by partners at higher levels. Operational staff also identified that implementation had been successful so far, with no major issues. Initial concerns had been raised by operational staff, but they understood any new policy implementation would have ‘bumps in the road’. Policing leads also mentioned that having consistency in approach when developing policies and processes was positive, and that consistency in application would be needed longer-term to ensure that RCRP processes and policies are embedded as ‘business as usual’. Operational staff mentioned that control room staff were confident in recognising when RCRP was to be used and said that RCRP is valuable for calls relating to mental health where staff, who may not have the skillset to handle such, can redirect them to the right partner.

Policing leads and operational staff identified some challenges with the practices and processes in the RCRP approach, and they acknowledged a culture shift for some control room staff is required. There needs to be a change in mindset to follow processes and sometimes make uncomfortable deployment decisions for RCRP, but this may be particularly difficult for those who have worked in the police for a while. Operational staff noted that, previously, call handlers would accept police involvement when it was not appropriate, but there has been a change and call handlers now challenge the need for police involvement more often. Operational police staff identified RCRP related challenges they faced where decisions are not clear, where responsibility falls on the call handler’s professional opinion, and when they feel guilty for not deploying officers to attend. A challenge was also noted with demand on partners’ resources that may impact the process for deciding attendance at incidents. Policing leads noted that guarantees of complete RCRP compliance cannot be made as decisions are made in good faith, but they may be incorrect. They also added that where a death is found after an RCRP decision, it may not relate directly to the process or application of the RCRP approach. Operational staff mentioned difficulties where processes differ with other forces who have not implemented RCRP, for example, when they accept transfer of an incident, which would not normally be accepted under RCRP.

3.1.5 Impact of RCRP

Police decision making when applying RCRP

Operational police staff reported using the NDM and THRIVE models to risk assess and develop a response in line with police legal responsibilities. They said the main difference with implementation of RCRP was being able to refer to official guidance with legal backing. They now have agreed legal advice with a specific framework to support their decision making, rather than using a professional judgement that may vary between call handlers. They also noted that responsibility depends on the scenario and the risk assessment can change; for example, if an incident is closed, it can be re-opened for a police response if the risk changes. Survey results showed that 90% of control room staff reported that they were aware of their legal responsibilities.

Policing leads and operational police staff described the impact of RCRP when reviewing RCRP decisions; for example, when RCRP had been applied and subsequently someone had been found deceased. They noted that, after a review of these specific cases, the deployment decision would not have changed the outcome; for example, because the ambulance service had attended and found the deceased person, rather than the police. They said feedback was encouraged for cases where a decision may have an impact on the outcome and the incident details are shared with operational staff to assess correct use of RCRP. Operational staff noted they had confidence in managers who review and challenge decisions they had made. For example, a domestic dispute incident involving alcohol could have been a medical or domestic abuse issue, and the deployment decision was reviewed by a supervisor and sergeant. The importance of support from other staff and senior colleagues was also noted by operational staff when making decisions and referring any ambiguities to supervisors.

Policing leads and operational staff identified the positive impact of RCRP for decision making, adding that RCRP had given them more confidence to make decisions, and challenge whether police involvement is needed. Findings from the survey showed that, for control room staff, 51% of survey respondents said they were somewhat confident and 23% said they were very confident to make decisions in line with the RCRP principles, but 15% felt neutral, and 11% were not very confident. Policing leads and operational police staff noted that call durations were becoming shorter as call handlers were using the structured set of questions in the toolkits to be more prescriptive and make quicker, more efficient decisions. Operational staff said call handlers were asking more questions to elicit additional facts and factors on which to make decisions; for example, when questioning health staff about the exact nature of their request for police attendance. Survey results showed 90% of control room staff responded that RCRP had a high or medium impact on their decisions to deploy patrols based on RCRP.

Researchers observed a call that took 2 call handlers 20 minutes to resolve, however, both call handlers agreed the time taken to make the decision would lead to an overall saving of officer time as deployment was not required, and the caller will be more aware when making future calls. Other observations of RCRP calls included quick decision making; one caller was advised to contact the mental health crisis team as no direct threat was established, another required police attendance, and social services took responsibility for another call.

“The work associated with a CfS [concern for safety] job is no extra time but there is a perception amongst [control room] staff that it does add additional time. But RCRP has meant handlers are able to deal with things more efficiently by working through a structured set of questions.”

Operational staff, EK04

Policing leads identified some challenges with consistency; for example, when other departments within the same police force, such as professional standards, agree with members of the public that a welfare check will be completed when the incident does not reach the threshold for deployment, which can lead to inconsistent RCRP decisions being made. Human error and learning new procedures for deployment were also identified as challenges; for example, teaching staff who had previously deployed patrols to incidents, and those who instinctively want to help people, not to deploy unnecessarily.

Challenges were also noted by operational police staff, including where dispatchers, who tend to have more experience than call handlers, review incidents and reverse the decision for police deployment. Operational staff also explained there were challenges in decision making when they feel uncomfortable about declining police deployment, particularly with people they want to help, and where they have an emotional response to the call. They explained that many RCRP decisions can also be borderline, there can be issues with ambiguity, decisions can be subjective, and they may be based on interpretation and experience. However, it was noted by one policing lead that following a review of deployment decisions, their force was attending some incidents that under RCRP they should not deploy to. They viewed this positively in that the police were attending where the decision was not clear, rather than not attending when they were required. Decisions for concern for welfare calls can be difficult, operational staff noted that the clear need to dispatch for a real and immediate risk to life in reference to Article 2 is not always recognisable, but they were trying to follow the correct decision-making process. They added that it can be difficult to apply RCRP principles when in a live call, and in real-life situations. They said there can be a fear that if you make the wrong decision the consequences will come back to you, which can cause concern for staff who, for example, have not received in-depth mental health training. In response to open survey questions, respondents also mentioned challenges they face when making decisions; comments included “add the human element and not all incidents are cut and dry”.

“Barriers could include officers and staff existing muscle memory and working practices, they have a can-do attitude and people are used to saying yes to everything (…) so the barrier may be decisions to want to help made by individuals.”

Operational staff, PH04

Operational outcomes for the police

Perceptions from policing leads and operational police staff following RCRP implementation included in reduction in demand and deployment. Participants reported time being freed up to refocus on incidents that were for police deployment and having the resource to attend them when required. In the survey, 85% of control room respondents also reported they thought deployment had decreased. Findings highlighted that while welfare checks had reduced, it should not be all about the numbers; qualitative aspects of decision making and public confidence in policing are also important. When considering impact, it was recognised that changes were happening across partner agencies; however, it is difficult for the police to measure what impact RCRP is having within partner organisations and for the public.

Survey results showed that 14% of other staff said RCRP had a high impact on their deployment to incidents, 46% reported a medium impact and 18% reported a low impact.

“I think both mentally with our officers and PCSOs [Police Community Support Officers] our frontline staff, that I’ve spoken to a number of teams, they’ve all noticed and comment positively about the impact it’s had. It has reduced our demand in, for example, welfare checks and enable (sic) us to focus on other things, which has been really positive.”

Policing lead, PE3

Policing leads and operational staff added that they have seen quicker dispatch and responses times. But others noted that extra time may be required for dispatch to grade 2 and 3 incidents (that require a priority, routine, or scheduled response), as deployment decisions may take longer to work out, but patrols now understand why they are going. They said that Article 2 or 3 ECHR incidents were being deployed to and they were getting deployment correct when there was an immediate risk to life or serious harm.

Operational police staff also noted that where decisions not to deploy are made a short time spent writing an RCRP incident report can save hours of police officer time. They added that frontline officers’ reactions to RCRP were positive, with officers coping better with their workload. Operational staff noted a positive effect on the length of time that incidents are opened and waiting for an officer to be deployed, by reducing non-police incidents, and there were fewer complaints about the length of time people were waiting for contact from officers. Survey results showed that 50% of control room respondents felt RCRP had a positive impact on their day-to-day workload, 43% said it was neutral, 4% said it had a negative impact and 3% were not sure. Survey participants were asked about possible burdens on their day-to-day workload after RCRP implementation. Respondents suggested that RCRP had created some additional stress when making decisions, with greater responsibility to make the right decision. RCRP was also reported to have increased workload initially through additional training to understand RCRP.

Conversely, operational staff also mentioned challenges that may impact operational outcomes, including the amount of time spent applying RCRP, and the volume of calls that have a concern for welfare or mental health element. The perception from operational staff was that about one-third of calls are mental health related and there was sympathy for callers as there is difficulty finding support in the NHS. Operational police staff identified that deployment grey areas can affect outcomes, where one small piece of information can change the decision to deploy or not. Others mentioned they had not noticed a difference in officer deployment, the push back from partners and compliance with partners’ current legal contracts may contribute to this, and there were always incidents waiting for deployment with no patrols to attend.

Outcomes for the public

Policing leads and operational police staff said they felt that with implementation of RCRP the public would receive a better and appropriate service; this would come from partner agencies who are trained in dealing with some incidents and people needing mental health care. It was felt that the police will be able to focus on other things, such as supporting victims of crime and young people through helping to set up crime prevention and rehabilitation of offender schemes. Policing leads thought the volume of calls from the public may not change with RCRP as the public lack knowledge about the reporting of incidents. But operational staff noted that the public do understand who to call for different scenarios and they know not to always call the police for mental health or other RCRP related problems. From the survey, 53% of control room staff responded that there was no difference in call volumes from the public relating to RCRP, 16% said they have decreased, and 29% were not sure if there has been any impact.

Operational staff said some calls from the public can be difficult, as they expect the police to attend all incidents when they call and they do not like the police saying no, however the public were understanding when RCRP was explained to them. It was noted that the police were encouraging the public to learn how to deal with certain situations, for example, to knock on a neighbour’s door and check they are well before calling the police. RCRP was useful for repeat callers as they can be redirected to the right partner. It was acknowledged that calls from the public were more likely to be Article 2 or 3 related, and the police will attend those. Operational staff said there were challenges for them when members of the public call saying that they want to end their life. They said they clarify with these members of the public whether the police are the appropriate service for them, which can be a difficult conversation when someone is in crisis or in need of help.

3.1.6 Training

The guidance documents and training materials relating to RCRP have been published at various times, as they were being reviewed and developed, and most were published after this research had been conducted. The absence of some guidance documents may be reflected in comments from research participants. Some forces produced their own toolkits and guidance that were based on the national packages.

Practices and processes

Survey responses showed that 99% of control room staff had received RCRP training. Policing leads and operational police staff reported the training included a thorough explanation of the RCRP approach and different scenarios, explanations of legal responsibilities, how to use the toolkits, learning from Humberside with examples, and measuring outcomes such as less deployment to RCRP incidents. Operational staff identified different training offers; it could be 2 hours or a whole day for call handlers, 3 weeks of classroom training sessions before implementation, a training session at every phase of RCRP rollout, or a 4-hour session for supervisors and inspectors. However, training packages may differ between forces.

Survey results showed that 68% of control room respondents who received RCRP training were satisfied with it, 21% were neither satisfied nor dissatisfied, and 10% were dissatisfied. It is important to note that, while different learning preferences exist, survey respondents from our research suggested that RCRP training could be improved with more time, in-depth content, and increased communication around policies, given the significance of the change.

Policing leads and operational police staff mentioned that training reinforced the importance of using toolkits to identify criteria and assess if calls meet the RCRP threshold, providing consistency and building confidence in decision making. They also noted that control room staff receive important information, such as weekly newsletters, leaflets, and blogs on RCRP, to help consolidate their training and highlight lessons learnt. Policing leads said that any new control room staff will be trained in RCRP.

Training for other staff was discussed by policing leads and operational staff - they highlighted the importance of training all police officers and staff, so they are aware of RCRP and know it focuses on control room decision making. Survey results showed that 41% of other staff respondents had received training. These included frontline and response officers, senior detectives, federation boards and heads of department. Policing leads identified helpful training had been provided by other forces, such as Humberside, and other departments, such as MASH. Policing leads and operational staff also noted joint training with the ambulance service was invaluable, with staff sharing experiences and learning from one another. It was also noted that FRS can help with some issues around RCRP, and moving forward, they will look at training and regulations together.

Policing leads mentioned that dip sampling, a method used to randomly review examples of RCRP training (HMICFRS, 2024), was used to assess what was working well, or not, to help people learn going forward. Operational staff identified it would be useful to add RCRP training to frontline officer information packs to access at any time. They also noted that having workers from a mental health charity in the control room during the first few weeks of implementation was helpful to provide ad hoc mental health information and feedback on cases to control room staff. Operational staff also noted that, while classroom training was useful, it was limited, reporting that real learning occurs through taking live calls and applying RCRP in practice. One survey respondent noted that training would be beneficial when different RCRP phases are being implemented; another respondent added that training could be improved with more time to prepare and longer inputs.

Policing leads identified challenges with training, including that newer staff understood RCRP as they were trained from the start, but staff with longer service had to break habits and become familiar with saying no to requests for police attendance. Policing leads and operational staff added that training can be a time-consuming process, with new and existing staff all needing to be informed about RCRP. Operational police staff felt less confident where training was not adequate, and they identified challenges when learning from scenarios presented in training, as these did not match real life. Operational staff also noted training was done prior to RCRP going live and time had elapsed since their training, so it was difficult to remember everything. They identified that refresher training would be helpful.

Support for staff

Operational and policing leads identified support from RCRP project teams and floor leads, who had more knowledge of RCRP and were approachable to discuss queries. They reported that floor walkers were helpful in clarifying any issues after training and in giving control room staff confidence beyond their training. Floor walkers who were mental health specialists were identified as helpful in supporting control room staff. It was noted that RCRP workbooks created a positive endorsement from senior leaders to show that control room staff have their support. Operational staff identified that other control room colleagues can help provide support to confirm each other’s decision making, adding that partners also gave presentations to support RCRP training.

3.1.7 Data collection

Practices and processes

Findings highlighted good practices in data collection and plans for accurately communicating and documenting data. Policing leads noted that data collection could be used in forecasting to understand future RCRP demand, and that incident tags applied to RCRP incidents allowed for tracking of incidents. They identified that data can be used for quality assurance testing, to review RCRP calls and identify areas of improvement, and to update internal strategic groups. Policing leads also mentioned that data can be shared that relates to the progress, impact, and outcomes of working with partners on RCRP. It was noted that work had been done with partners to analyse data trends. Policing leads also noted that PCCs could review RCRP data and ensure it is collected accurately. They identified positive work relating to the collection of data, including the preparation of statistics, performance measures, dashboards, and data infographics, that were being sent to project teams and call handlers.

Operational police staff also said they were recording data to feedback details for handover times and waiting times. One mentioned that QR codes could be created that enabled officers to record any arrest at an ED, wait times for patients held under s136, those who were being admitted voluntarily and those covered by the Mental Capacity Act, 2005, or other wait times. It was also noted that every decision was detailed, and notes were added to the incident toolkit form that were checked for compliance with policies.

Handover time recording (CoP, 2023c)

The findings were varied on how handover times were being recorded and whether they had changed since RCRP implementation. Policing leads mentioned challenges when recording handover times, noting they are not recording the times accurately; for example, if 2 officers attend, it will be recorded as 6 hours not 12 hours. Another participant noted handover times for mental health incidents or waiting for an ambulance will be recorded on individual incidents, but they have no way of pulling this data from their command-and-control systems. One participant noted their recording of handover times to hospitals had improved and there was a process in place for recording initial attendance and arrival handover time.

Incident data recording

Policing leads and operational police staff identified the use of qualifiers or tags to record RCRP incidents, and the recording of THRIVE assessments to incident records. Some operational staff said incident data is recorded accurately and graded with dispatch and arrival times. A researcher observed a call handler immediately identifying an incident as RCRP and spending time checking their notes to ensure they recorded everything accurately. However, other operational staff mentioned challenges they faced when recording incidents: incidents may not be opened or closed accurately due to time pressures; for example, when patrols do not update when they are at the scene, or if they deploy to an incident without telling the dispatcher. It was noted that some forces do not have accurate mechanisms for recording the time spent at a scene.

Operational staff noted changes in recording of incidents: they noted an increase in records created for ‘concerns’ as they now record everything related to RCRP, even when the incident is not for police involvement, and public and partner agency calls are recorded on different forms. Policing leads said that records containing this information were used for assessing data and decision making, giving more confidence to their data analysis.

Policing leads identified some manual processes for collecting data on incidents and deployment but said that good record management and dedicated analytical resources are required. They also recognised that they faced challenges where they do not have access to analytical tools, like Power BI, that enable the automatic collection of incident data. Policing leads acknowledged challenges with monitoring data, noting that there were some data quality issues when using a manual process. They also noted that data monitoring for s136 detentions was challenging, and the use of different crime recording systems across forces made comparisons difficult. Tracking outcomes for individuals, for example, a person who has engaged with mental health services, was also difficult.

3.1.8 Early quantitative findings

Police perceptions of a reduction in demand were supported by a quantitative analysis of police incident data. Early data monitoring indicates that each of the forces in the sample observed savings of police officer time following implementation of RCRP. For most forces, this refers to implementation of phase 1 ‘concern for welfare’, or policies similar to this phase that were implemented prior to the national guidance and were later rebranded and brought in line with RCRP. In some cases, forces implemented all phases at the same time, including the ‘concern for welfare’ phase.

Throughout the discussion of the following findings, there is an important distinction to be made between ‘concern for safety’ and ‘concern for welfare’. When referring to ‘concern for safety’, this describes the incident type category applied by forces to categorise and classify incidents. When referring to ‘concern for welfare’, this is in reference to the phase of RCRP that is sometimes considered ‘phase 1’. While these phrases may often be used interchangeably by forces in other contexts and can refer to the same thing, they have been used distinctively here to refer to these different concepts more clearly.

The following findings are displayed by force sampled to allow for an understanding of early quantitative changes observed based on each force’s implementation plans. Findings refer to concern for safety (CfS) incidents, mental health (MH) incidents, RCRP qualifiers and other considerations where available from each force.

MH incidents refer to incidents that had a mental health qualifier applied. In these cases, the incident itself could be any type of crime, non-crime or administrative incident, but the call handler deemed MH to be a relevant factor. For example, the incident itself could be theft, but if the individual committing the offence was experiencing MH issues, then the qualifier may be added to provide further detail to the incident record. This measure has been included to give some insight into mental health-related demand.

It is important to note that forces should not be directly compared as they implemented RCRP policies in different ways and at different times. For this reason, analysis does not use a standardised ‘pre-implementation’ and ‘post-implementation’ timeframe for all forces. Instead, the individual implementation dates for each force are considered, with a year of data prior to this date considered ‘pre-implementation’ and any data generated between go-live and January 2024 considered ‘post-implementation’. Therefore, the amount of post-implementation data for each force varies, and pre-implementation data may be affected by different seasonal trends or external factors for each force. This is a limitation of the analysis. However, this provided the most comprehensive and comparable approach that maximised the amount of post-implementation data.

3.1.9 Essex Police

Essex Police went live with the ‘concern for welfare’ phase of RCRP in September 2023. They had already established a partnership agreement for police response to CfS incidents over the 18 months prior to their official go-live date for RCRP. This go-live included a further push on internal compliance, training of call handlers and introducing additional governance measures.

Concern for safety incidents

There was an average of 621 fewer CfS incidents that were deployed to each month following implementation, compared to the same 4-month period the year prior to implementation. This reduction in CfS incidents equates to an estimated 4,840 hours of officer time saved on average each month, assuming 2 officers would have attended each incident. Across the 5-month period (September 2023 to January 2024) post implementation, an estimated 24,230 officer hours were saved, a 46% saving in officer time spent on CfS incidents. The PPR reported equivalent hours for one full-time equivalent (FTE) officer as 1,768 hours per year, or around 147 hours per month. This estimated time saved on average each month is equivalent to the hours worked by 33 FTE officers.

There has been a noticeable reduction in the number of CfS incidents and deployments. From September 2022 to January 2023, 11,984 CfS incidents were recorded (7.1% of all incidents), with 56.8% of these CfS incidents being deployed to. In the months after implementation, from September 2023 to January 2024, there were 7,123 CfS incidents (4.6% of all incidents). The proportion of these incidents that were deployed to decreased to 51.9%. This demonstrates a reduction of 4,861 CfS incidents and a 4.9 percentage-point reduction in deployment to them.

Figure 1: Essex Police concern for safety (CfS) incidents and deployments between September 2022 and January 2024

There has been a noticeable reduction in the number of CfS incidents and deployments. From September 2022 to January 2023, 11,984 CfS incidents were recorded (7.1% of all incidents), with 56.8% of these CfS incidents being deployed to. In the months after implementation, from September 2023 to January 2024, there were 7,123 CfS incidents (4.6% of all incidents). The proportion of these incidents that were deployed to decreased to 51.9%. This demonstrates a reduction of 4,861 CfS incidents and a 4.9 percentage-point reduction in deployment to them.

Since September 2022, there were no pronounced trends in incident numbers or the rate of deployment to these incidents until August 2023. Essex Police reported that internal work around communications and working practices began in July 2023, once the NPA had been released. Therefore, a reduction in both CfS incidents and deployments were expected, and can be observed, in August 2023 prior to the official go-live date. Although, it is important to note that Essex Police had already made policy changes around CfS incidents over the 18 months prior to their official go-live.

The focus placed on RCRP externally, through publication of the NPA and national guidance, and internally, through training and reinvigoration of policies, appears to have had a noticeable effect on incidents and deployments. From August 2023 and for each of the months afterwards, there was a clear decline in the number of CfS incidents and deployment to them. This is consistent with implementation and these trends may reflect the gradual embedding of processes and policies, in terms of both those contacting the police becoming more aware, and call handlers becoming more comfortable applying these policies.

3.1.10 Metropolitan Police Service (MPS)

The MPS implemented all RCRP phases at the same time, in November 2023. These phases include ‘concern for welfare’, ‘walk out of healthcare facilities and AWOL from a mental health establishment’, ‘transportation’ and ‘section 136 of the Mental Health Act and voluntary mental health patients’.

Concern for safety incidents

There was a monthly average of 6,046 fewer CfS incidents that were deployed to in the months after implementation, compared to the equivalent months the year prior. This equates to an estimated 18,910 hours of officer time saved on average each month following implementation, assuming 2 officers would have attended each incident. For the 3-month period following implementation (November 2023 to January 2024), a total of 56,740 officer hours are estimated to have been saved. This is a 56% saving in officer time spent on CfS incidents compared to the same period in the previous year. This estimated time saved on average each month is equivalent to the time worked by 129 FTE officers.

Findings show a noticeable reduction in the number of CfS incidents and those deployed to. From November 2022 to January 2023, there were 55,655 CfS incidents recorded (5.7% of all incidents), with 58.3% of these incidents being deployed to. In the months after implementation, from November 2023 to January 2024, 39,424 CfS incidents were recorded (3.9% of all incidents). Deployment to these incidents reduced to 36.4%. In this 3-month period, this was a reduction of 16,231 CfS incidents and a 22 percentage-point reduction in deployment to them.

Figure 2: Metropolitan Police Service concern for safety (CfS) incidents and deployments between November 2022 and January 2024

Mental health incidents

In this analysis, MH incidents refer to any incident that had ‘MH’ applied as one of the 3 available descriptors when the incident was opened by call handlers.

From November 2022 to January 2023, there were 34,195 incidents with a MH incident type recorded (3.5% of all incidents) and these were deployed to in 23.4% of cases. From November 2023 to January 2024, 30,326 of these incidents were recorded (3% of all incidents) and these were deployed to in 16.2% of cases. This represented a reduction of 3,869 MH incidents and a 7.2 percentage-point reduction in deployment.

Figure 3: Metropolitan Police Service mental health (MH) incidents and deployments between November 2022 and January 2024

Right Care, Right Person incidents

As the MPS implemented all RCRP phases at the same time, they have used additional incident types to account for monitoring of RCRP related incidents. The following findings consider any incident that had at least one of the following descriptors applied when the incident was opened by call handlers:

CfS
MH
vulnerable
collapse/illness/injury/trapped
welfare check request

These incidents will be referred to as ‘RCRP related incidents’. Incidents with the descriptors of CfS and MH included in this grouping are the same as those referred to in the respective CfS and MH analysis sections. The analysis of CfS and MH should not be combined with the RCRP related incidents analysis, as these incidents are included in this grouping already and this would result in repetition of the incidents being represented.

There was a monthly average of 6,775 fewer RCRP related incidents that were deployed to in the months after implementation, compared to the equivalent months the year prior. This equates to an estimated 23,520 hours of officer time saved on average each month following implementation, assuming incidents would have been attended by 2 officers. For the period following implementation (November 2023 to January 2024), a total of 70,560 officer hours are estimated to have been saved. This is a 42% saving in officer time spent working on RCRP related incidents compared to the same period in the previous year. This estimated monthly saving is equivalent to the hours worked by 160 FTE officers in a month.

Figure 4: Metropolitan Police Service RCRP incidents and deployments between November 2022 and January 2024

Findings show a pronounced decline in both the number of RCRP related incidents and deployment to them in November 2023 and over the months that followed. In the year prior to RCRP implementation, between November 2022 and January 2023, 104,187 RCRP related incidents were recorded (making up 10.6% of all incidents received by the MPS). These incidents had a deployment rate of 46.1%. In the 3 months after implementation, 85,547 RCRP related incidents were recorded (making up 8.5% of all incidents) and were deployed to at a rate of 32.3%. This demonstrates a reduction of 18,640 RCRP related incidents and a 13.7 percentage-point reduction in the rate of deployment to these incidents.

3.1.11 Northamptonshire Police

Northamptonshire implemented all RCRP phases in July 2023. These phases include ‘concern for welfare’, ‘walk out of healthcare facilities and AWOL from a mental health establishment’, ‘transportation’ and ‘section 136 of the Mental Health Act and voluntary mental health patients’. This analysis focuses on the ‘concern for welfare’ phase by considering CfS incidents. In Northamptonshire, the RCRP policies implemented only apply to incidents and requests originating from other agencies but not to incidents from the public.

Prior to RCRP implementation, many of the practices associated with RCRP had already been effectively adopted in all but name, and had been for several years, before the official go-live date. This included a robust ‘welfare check’ policy, which had been communicated to and acknowledged by partners. As part of these practices, Northamptonshire was already routinely pushing back on partner agency requests prior to implementation and therefore may not observe a noticeable decline in incidents or deployment after their go-live date.

Concern for safety incidents

There was a monthly average of 90 fewer CfS incidents that were deployed to in the months after implementation, compared to the equivalent months the year prior. This equates to an estimated 1,030 hours of officer time saved on average each month following implementation, assuming 2 officers would have attended each incident. For the 7-month period (July 2023 to January 2024) following implementation, a total of 7,240 officer hours are estimated to have been saved. This is a 6% saving in officer time spent on CfS incidents compared to the same period in the previous year. This estimated time saved each month is equivalent to the hours worked by 7 FTE officers.

From July 2022 to January 2023, 18,891 CfS incidents were recorded by Northamptonshire (18.3% of all incidents recorded), with 57.2% being deployed to. In the months after implementation, from July 2023 to January 2024, 19,069 CfS incidents were recorded (17.6% of all incidents recorded). The proportion of these incidents that were deployed to decreased to 53.4%. Therefore, there was a marginal increase of 178 CfS incidents but a 3.8 percentage-point reduction in the rate of deployment to these incidents.

The number of CfS incidents deployed to and the rate of deployment was generally lower each month after implementation, compared to the same month the year prior. Although, in terms of the number of CfS incidents, some months after implementation had a higher number compared to the equivalent month a year prior. Due to the policy changes Northamptonshire had already made prior to the go-live of RCRP, a pronounced decrease in these incidents was not necessarily expected. The slight increases observed in some months could be a result of policy changes introduced through RCRP, where incidents that may not have been recorded previously if officers were not deployed, are now being recorded.

Figure 5: Northamptonshire Police concern for safety (CfS) incidents and deployments between July 2022 and January 2024

Mental Health incidents

Northamptonshire apply qualifiers to their incidents to provide additional information and categorisation. Any incidents that had the qualifier ‘MH’ applied to it were included in this analysis.

From July 2022 to January 2023, 5,989 incidents with a MH qualifier were recorded (making up 5.8% of all incidents) and were deployed to in 56.9% of cases. From July 2023 to January 2024, 5,122 of these incidents were recorded (making up 4.7% of all incidents) and were deployed to in 46.8% of cases. This was a reduction of 867 MH incidents and a 10.1 percentage-point reduction in the rate of deployment to these incidents.

Across the months of data captured, the number of MH incidents fluctuated slightly from month to month, but there was not a particularly pronounced decline following implementation. Year-on-year comparisons show an average of 124 fewer incidents with a MH qualifier applied recorded each month following RCRP implementation.

The rate of deployment to MH incidents showed a more noticeable reduction between June 2023 and August 2023, consistent with implementation in July 2023. The rate of deployment then increased slightly and remained fairly stable between September 2023 and January 2024, but at a lower rate than the year prior to implementation.

Figure 6: Northamptonshire Police mental health (MH) incidents and deployments between July 2022 and January 2024

Other agencies

The origin of incidents recorded by Northamptonshire from external agencies was explored as the RCRP policies implemented only apply to incidents and requests originating from other agencies. An incident was considered as one originating from ‘external agencies’ if it was categorised as being received from: ‘government agencies’, ‘partner organisations’ or ‘other agencies’.

Between July 2022 and January 2023, 8,767 incidents were received from external agencies (making up 8.5% of all incidents recorded) and of these, 43.7% were deployed to. Post implementation, from July 2023 to January 2024, 9,642 of these incidents were recorded (making up 8.9% of all incidents) and were deployed to at a rate of 31.9%. This was an increase of 875 incidents recorded by external agencies but a 11.8 percentage-point reduction in the rate of deployment.

This slight increase following implementation may reflect changes made to the recording of incidents for all partnership requests. Where these incidents were not attended by police previously, they may not have been saved on the incident recording system. There has been a process change since the implementation of RCRP that may support this increase in the number of these incidents recorded.

The overall lower levels of deployment may similarly reflect the changes to the way in which incidents are recorded following RCRP implementation. Previously, these incidents may have been recorded less consistently and sometimes not logged where deployment did not take place. As a result of this change in practice, where incidents that are not being deployed to are being recorded at a higher rate, the rate of deployment is likely to reduce.

3.1.12 South Yorkshire Police (SYP)

SYP implemented the first ‘concern for welfare’ phase of RCRP in March 2023. ‘Walk out of healthcare facilities’ and ‘AWOL from a mental health establishment’ phases were implemented in July 2023 and October 2023, respectively.

Concern for safety incidents

There was a monthly average of 662 fewer CfS incidents that were deployed to in the months post implementation, compared to the equivalent 11-month period in the year prior. This equates to an estimated 3,390 hours of officer time saved on average each month, assuming 2 officers would have attended each incident. A total of 37,320 officer hours are estimated to have been saved for CfS incidents between March 2023 and January 2024. This is a 35% saving in officer time spent compared to the same period in the previous year. Therefore, the estimated time saved each month is equivalent to having around 23 FTE officers available each month.

Figure 7: South Yorkshire Police concern for safety (CfS) incidents and deployments between March 2022 and January 2024

From March 2022 to January 2023, 35,583 CfS incidents were recorded by SYP (11.3% of all incidents), with 58.8% of these incidents being deployed to. Following the implementation of the ‘concern for welfare’ phase of RCRP, from March 2023 to January 2024, 28,470 CfS incidents were recorded (9.1% of all incidents) and 47.9% were deployed to. This represents a reduction of 7,113 CfS incidents and a 10.9 percentage-point reduction in the proportion of these incidents that were deployed to.

Following implementation in March 2023, there was an overall decrease in the number of CfS incidents received in the months that followed. The rate of deployment to these incidents fluctuated slightly over these months but remained at lower levels compared to the equivalent period in the year prior. There was a more noticeable increase in the deployment rate observed in January 2024, where the highest deployment rate was recorded since RCRP had been implemented. However, there were still fewer CfS incidents, and a lower deployment rate compared to January 2023. The deployment increase in January 2024 suggests that the incidents being received may be more likely to require police attendance, resulting in a higher level of deployment to a lower number of incidents. This increase in the deployment rate observed in January 2023, several months after RCRP had been implemented, may also be a result of these practices having become more embedded and established. As data was collected up to January 2024, SYP had the most months of post-implementation data of the forces sampled and therefore trends observed for SYP may be seen in other forces once processes have had more time to embed.

Mental health incidents

SYP apply qualifiers to their incidents to provide additional information and categorisation. Any incidents that had at least one of the following qualifiers applied was considered a ‘mental health incident’: MH, s135, s136 and suicide threat.

From March 2022 to January 2023, prior to RCRP implementation, there were 11,277 incidents with a MH qualifier applied (3.6% of all incidents) and these incidents were deployed to in 60.9% of cases. From March 2023 to January 2024, 8,407 of these incidents were recorded (2.7% of all incidents) and were deployed to in 57.2% of cases. This was a reduction of 2,870 incidents with a MH qualifier recorded and a 3.7 percentage-point reduction in the rate of deployment to these incidents.

Figure 8: South Yorkshire Police mental health (MH) incidents and deployments between March 2022 and January 2024

Right Care, Right Person qualifiers

To support the implementation of RCRP, SYP introduced several new qualifiers to monitor the number of RCRP incidents. From March 2023 to January 2024, an average of 491 incidents a month were flagged as ‘RCRP police will not attend’. This demonstrates the implementation and use of qualifiers to support baselining and monitoring within forces. This also supports the interpretation that the reduction in incidents seen across CfS incidents and those with a MH qualifier may be associated with RCRP to some extent.

SYP also implemented a qualifier to identify RCRP related incidents where police did attend, which was applied on average 17 times a month between March 2023 and January 2024. A further qualifier was also introduced that identifies incidents where police may attend but the call handler escalated this to their supervisor to review. This was applied on average 6 times a month.

3.1.13 Thames Valley Police

Thames Valley Police (TVP) implemented their ‘welfare checks’, ‘absconding from healthcare’ and ‘AWOL from a mental health establishment’ phases in May 2023. However, this analysis will solely focus on the ‘welfare checks’ phase, which is comparable to the ‘concern for welfare’ phase.

Concern for safety incidents

There was a monthly average of 611 fewer CfS incidents that were deployed to in the months after implementation, compared to the equivalent months the year prior. This equates to an estimated 2,490 hours of officer time saved on average each month following implementation, assuming 2 officers attend each incident. Following RCRP implementation, a total of 22,410 officer hours are estimated to have been saved between May 2023 and January 2024. This is a 33% saving in officer time spent on CfS incidents compared to the same period in the previous year. This estimated saving each month is equivalent to the hours of around 17 FTE officers working for a month.

Figure 9: Thames Valley Police concern for safety (CfS) incidents and deployments between May 2022 and January 2024

From May 2022 to January 2023, 27,463 CfS incidents were recorded by TVP (10.9% of all incidents). Of these incidents, 61.4% were deployed to. In the months after implementation, from May 2023 to January 2024, this reduced to 18,286 CfS incidents being recorded (making up 6.3% of all incidents). However, deployment to these incidents increased to 62.2%. This suggests that CfS incidents were attended by officers at a slightly higher rate after RCRP, as the number of these incidents decreased.

The consistently higher rates of deployment to lower numbers of incidents suggest that the incidents that are being recorded in the months following implementation are more often those that require police attendance.

Mental health incidents

TVP applies qualifiers to their incidents to provide additional information and categorisation. Any incidents that had at least one of the following qualifiers applied was considered a ‘mental health incident’:

MH
attempted suicide
suicide
self-harm

TVP advised that a significant amount of time in their RCRP training, feedback and learning was spent on consideration of incident types and how these are applied. During this training, some reluctance was identified in recording an incident as MH, as call handlers did not feel confident in making this assessment based on the information available. The training and work around RCRP aimed to address this reluctance in applying the MH qualifier and therefore TVP advised that a rise in incidents recorded as MH was expected on this basis, as call handlers applied the MH qualifier more often than they did prior to RCRP.

Figure 10: Thames Valley Police mental health (MH) incidents and deployments between May 2022 and January 2024

From May 2022 to January 2023, 7,618 incidents with a MH qualifier applied were recorded (which made up 3% of all incidents) and these were deployed to in 58.7% of cases. From May 2023 to January 2024, 17,159 MH incidents were recorded (which made up 5.9% of all incidents) and these were deployed to in 58.6% of cases. This demonstrates an increase of 9,541 in the number of MH incidents, while the rate of deployment remained consistent.

From May 2022 to January 2023, the average number of these incidents recorded each month was 846. This increased to an average of 1,907 incidents in the same period after implementation. Between May 2022 and March 2023, the number of MH incidents remained at fairly consistent, low levels. A dramatic increase was then observed from April 2023 to January 2024, despite RCRP going live in May 2023. This may reflect the completion of training in April 2023, which included a significant focus on incident recording, where the initial increase in MH incidents can be observed. The deployment rate to MH incidents has remained fairly stable before and after implementation.

3.1.14 Key insights

It is important not to compare forces directly as each differs in terms of RCRP implementation timings, geographical area, organisational structure, and operational context. However, using the population of each police force area, an estimate of officer hours saved per 100,000 people (see table 1 below) has been calculated. These analyses have enabled a consistent calculation as they consider the proportionate population size for each force area, although they still do not take all differentiating factors into consideration.

Humberside police estimated a saving of 1,441 officer hours each month following RCRP (CoP, 2023b). Previous estimations of annual time savings across all forces, if they were to realise time savings similar to those reported by Humberside, noted a possible saving of around one million hours of police officer time per year (CoP, 2023d). Considering the calculations applied to forces in the sample, Humberside sits around the median. This suggests that, generally, the time savings estimated in Humberside were comparable with the time savings seen by the forces in this sample.

Despite the varied approaches and timelines, findings from each of the 5 forces included in the sample demonstrated a reduction in calls received about CfS incidents, and the number of these incidents that were deployed to, following RCRP implementation. Estimates suggest that each force has saved officer time as a result of these reductions, which could be redirected elsewhere to focus on key policing responsibilities. What the time saved may be used for is beyond the scope of this evaluation.

Table 1: Estimated officer hours saved across forces per month

Force	Estimated hours saved (per month)	FTE officer equivalent (hours saved per month)	Hours saved per 100,000 in force area (monthly)	FTE officer equivalent (per 100,000 monthly)
Essex	4,840	33	322	2
MPS	18,910	129	215	1
Northamptonshire	1,030	7	132	1
SYP	3,390	23	247	2
TVP	2,490	17	99	1

3.2.1 Implementation findings

The findings in this section include quantitative and qualitative evidence collected in the June 2023 and March 2024 implementation surveys issued by DHSC to ICBs and LAs (see annex F for full survey findings and questions), as well as qualitative findings from the research by academics from the University of York and the King’s Fund commissioned by DHSC. The findings are organised by key themes along the outlined research questions (see section 1.3.3 DHSC research activities).

The section on perceived impacts outlines the early perspectives of representatives from health and social care services of RCRP impact. It is important to note that these are early insights of perceived impacts from respondents to the ICB and LA survey who oversee the implementation of RCRP, as well as from interviews with frontline staff, and are not quantitatively measured impacts. Furthermore, the surveys conducted by DHSC were shared with all ICBs and LAs regardless of whether they had started implementing RCRP phases or not at the time. Therefore, the survey findings may include responses from ICBs that had not yet started implementation of RCRP.

3.2.2 Implementation process

In June 2023, a few ICBs reported they had already implemented the principles of RCRP while most were engaging in early conversations internally and with local partners. These early conversations were used to discuss the principles of RCRP. Some ICBs had established more regular meetings to discuss timescales and implementation stages. However, a few ICBs reported that police forces were changing their response to incidents (such as, implementing RCRP) without engaging their health partners. At this point, most ICBs estimated needing between 6 months and 2 years to fully implement RCRP.

In March 2024, ICBs and LAs were asked about progress towards implementing RCRP - between 74% and 54% of responding ICBs and between 58% and 30% of LAs had implemented or agreed a date for implementation of at least one phase. ‘Concern for welfare’ was the most widely implemented phase according to ICBs and LAs. Other phases followed (listed in descending order of already being implemented or scheduled): Patients absent from inpatient mental health facilities/not returning from leave, patients leaving health care facilities before completing their treatment, reducing s136 handover times and transportation (conveyance) of patients.

Healthcare professionals highlighted some implementation phases which posed specific challenges: concern for welfare, s136 handovers and conveyance (Jefferson, et al., 2024).

Among case study interviewees from the health sector, there was a consensus about the over-reliance on police when it comes to concerns for welfare. However, healthcare professionals highlighted challenges with implementation, such as instances of different understandings of risk among involved agencies, and that responsibilities were not always clear with regards to which agency would be responding. In practice, this meant, for example, that ambulances were often relied upon but did not necessarily see concern for welfare calls as part of the commissioned services they provide, given their role to provide emergency healthcare. Linked to this, ambulance services felt they were often limited in their capacity and/or capability to respond. Interviewees expressed concerns that people not engaged with statutory services, who often face high levels of inequalities and marginalisation, may not receive an adequate response to concerns for welfare. A lack of relevant information about the individual in the system, that would be needed for them to meet the threshold for police response, was stated as a contributing factor. Questions also emerged in relation to legal responsibilities and powers. Powers of entry was mentioned as an area lacking clarity. Other concerns were stated around requesting families and patients to change their behaviour, for example police control room staff asking them to redial 999 and ask for the ambulance service instead of the police. The management of patients who have walked out of healthcare facilities or did not return from leave was expected to mostly impact staff in EDs and inpatient care settings.

Regarding reducing s136 handover times, healthcare professionals saw challenges around resourcing and infrastructure and some doubt that one-hour handovers are realistic. A lack of HBPoS availability and the need for 24/7 staffing were mentioned as well as the fact that MHA assessments require the attendance of several professionals, including AMHPs and section 12 (s12) approved doctors. Interviewees also highlighted the need to consider provision for children and young people when thinking about HBPoS capacity. In some cases, EDs became a backup when HBPoS capacity was reached. Challenges for healthcare professionals included instances of police colleagues leaving without mutual agreement or bringing people in under s136, without patients meeting the legal framework for detention. For example, interviewees in one area perceived that a greater proportion of people under the influence of drugs and alcohol (where it may not be clear if the individual is at risk due to their mental health or not) were now being detained under s136 and taken to a HBPoS for assessment. It was suggested by interviewees that this was because a HBPoS may have faster processing times than A&E, shortening the potential handover time for police to meet the one-hour handover target.

Conveyance was perceived as the least-well defined area of the RCRP framework and agreements were therefore made very locally, at times on a provider level. Interviewees were concerned about the speed of response due to ambulance capacity, service pressures, and capacity issues in the wider system. Some interviewees reported investing in the use of private ambulances for conveyance of patients, as the staff for these ambulances are often specifically trained to transport patients who are at a higher risk of harm to themselves or others. Implementation challenges include the misuse of legal frameworks for conveyance (such as the Mental Capacity Act) and risk management as not all members of staff involved in conveyance are trained to restrain patients when needed. Some interviewees reported that prior groundwork with partners on this topic had eased the transition during this phase.

3.2.3 Partnership working

In June 2023, most ICBs indicated good working relationships with their local police forces, however, many also stated the need to improve collaboration, and a few indicated that their police force was acting unilaterally.

In March 2024, ICBs and LAs were asked about details on their partnership arrangements. Across the respondents, health partners (for example, Mental Health Trusts, Acute Trusts, Ambulance Trusts), LAs and local police forces were well integrated. For example, 97% of responding ICBs and 82% of LAs reported that Mental Health Trusts were included in their local partnerships, and 94% of ICBs and 89% of LAs have local partnerships with their local police forces. Other stakeholders were less widely included in RCRP partnerships. Fewer than half the responding ICBs and LAs included wider services for children and young people (47% of ICBs and 44% of LAs), people with lived experiences (44% of ICBs and 22% of LAs) or NHSE-led Mental health, learning, disability, and autism (MHLDA) provider collaboratives (41% of ICBs and 28% of LAs).

Examples of how ICBs and LAs had been navigating partnership working include ensuring that working groups have a good representation of agencies in their area, discussing developments with partners, and reviewing individual incidents together.

“[RCRP] has allowed for more opportunities for frequent contact and good engagement across the system.”

“Strong multi-agency working has been established through our governance structures.”

A few LAs also gave examples of the different groups or meetings, such as monthly multi-agency meetings and weekly RCRP meetings with their local mental health police liaison team, that form their partnership arrangements, as well as working with police forces, ambulance services, and acute care.

In interviews, healthcare professionals explained that partnerships have been initially strained where the implementation process was perceived to be unilaterally led by the police. Communication was a key factor in improving relationships, as was local leadership role modelling collaborative ways of working. Areas which have stronger relationships prior to the NPA have also reported smoother transitions when implementing RCRP. An understanding of different cultures and pressures across the relevant partner organisations was needed to build strong partnerships (Jefferson, et al., 2024).

3.2.4 Critical success factors

Relationships

Ahead of implementation, in June 2023, ICBs stated that “engagement” was a key requirement of implementation in their view. This engagement would be needed to devise roles and responsibilities, to share data and, if possible, establish an individual memorandum of understanding between ICBs and police forces.

In March 2024, relationship building seemed to have been largely successful as key stakeholders were mostly integrated in local partnerships. When asked to choose a single most obstructive barrier to implementation, none of the ICBs and only 2 LAs chose ‘multi-agency collaboration at local level not working well’. ICBs and LAs were also asked about the composition of their local partnerships and more than 90% of ICB respondents had police, health and LAs partners included in their partnership arrangement, more than 50% of ICB respondents’ partnerships also included fire services (68%), safeguarding boards (56%), and VCSFE organisations (62%). However, some stakeholders were less widely included, some were included in fewer than 50% of respondents’ partnerships. These stakeholders were wider services for children and young people (47%), people with lived experience and their carers (44%), and NHSE-led MHLDA provider collaboratives (41%). It is important to note that across the country at the time of the research, some police forces were awaiting guidance from the CoP before determining next steps on applying RCRP to children and young people and were therefore not moving forward with RCRP in relation to children at this point. The composition of local partnerships was largely similar for responding LAs with the addition that fire services and VCSFE stakeholders were less well integrated among responding LAs compared to responding ICBs, with only 47% of LAs reporting that local fire services and 47% of VCSFE stakeholders were included in their local partnerships.

When ICBs were asked about how they were overcoming any barriers, a few referenced that good engagement in several areas, such as governance, structure, roles and responsibilities, communication, data, and escalation processes, had helped with implementation.

“There has been excellent local collaboration at a senior and on the ground level to implement RCRP at pace, despite the time pressure, and to work through clarity of responsibilities and problem solve cases as they arise.”

A few ICBs and LAs discussed how collaborative partnership working with agencies, such as the police, was helping to resolve safety incidents.

“Our local police force are working collaboratively with us to ensure any issues raised will be looked into and these will be addressed through shared learning.”

Overall, when asked if there was anything they wanted to share about their general experience of implementing RCRP in their local area, several ICBs and a few LAs mentioned having strong partnership working across agencies and that there had been good collaboration with partners. There were specific mentions of considerate and collaborative approaches being taken by police forces by both ICBs and LAs. Some ICBs and LAs had negative experiences working with the police, which are detailed later in the report to refrain from duplication here

“We have developed strong relationships and our police force have been exemplary in working collectively with us to implement, listening to partner feedback and adjusting timescales as required.”

However, although represented in most local partnership arrangements, a few LAs perceived that implementation had been led predominately by police and ICBs, resulting in some feeling that LAs had not had as equal a role as other agencies in decision making related to RCRP. One LA did mention there had been a lack of collaboration with them at points.

“The process has been very much police and ICB led which has not always been collaborative.”

Interviewees mentioned that embedding police and health colleagues in interdisciplinary teams was a good strategy to support relationships. Healthcare professionals also mentioned that training police colleagues in mental health has enhanced partnership working and facilitated the coordination of incident responses (Jefferson, et al., 2024).

Communication

In June 2023, ICBs highlighted that a lack of communication and clarity could pose a risk to implementing RCRP. In March 2024, there is some evidence of a lack of communication; for example, 5 ICBs and 10 LAs reported not knowing their local police force’s position on whether RCRP was being applied to children and young people.

However, good communication also smoothed implementation. In interviews, healthcare professionals gave examples of good communication, such as the use of temperature checks to assess the readiness for implementation, communication to identify training needs and a close involvement of senior health representatives in strategic and tactical police-led meetings (Jefferson, et al., 2024).

Resource

In June 2023, ICBs expressed the need for more resource to implement RCRP, with several respondents mentioning workforce and capital requirements. In that context, ICBs also highlighted wider staff shortages in the health sector. Respondents emphasised that hiring locum staff to balance the resource needs would be associated with higher costs. In some cases, ICBs also suggested the need to hire specific project management staff for the implementation of RCRP. A lack of funding and shortage of staff were seen as potentially endangering patients and staff following the changes brought about by RCRP. The reduced involvement from the police may uncover demand for health and social care services that were previously picked up by the police. Respondents were also conscious that other mental health services might not be able to compensate if their staffing levels were also reduced to enable RCRP implementation.

In March 2024, only a few ICBs and none of the responding LAs had made detailed and firm assessments of whether any additional funding was needed. However, a larger proportion said this was in development. Very few responding ICBs (3% of respondents) and LAs (8% of respondents) stated that they had assessed the need for additional funding and concluded there was none. When asked about the single most obstructive barrier to implementation in their area, cost/funding pressure was the top barrier selected by ICBs, with 29% of respondents who had experienced barriers choosing this option. LAs also experienced cost/funding pressure (50% of respondents) but lack of workforce (64% of respondents) was a more prominent barrier, which also ranked high among the list of barriers selected by ICBs (67% of respondents). Issues with workforce resources and the general capacity to deliver RCRP, when demand is already high and resources are decreasing, was mentioned as a challenge by a few ICBs. Furthermore, a few ICBs, when asked about their experience of implementing RCRP, mentioned that a lack of additional funding is making implementation challenging.

“Capacity to deliver safe and effective care in the context of increasing demand on all services and diminishing resources is also a challenge.”

When asked about actions to overcome barriers, a few ICBs gave examples of how they were overcoming barriers related to resource issues. Examples included using third sector organisations and recruiting more staff to EDs. Other specific actions included evaluating cost pressures and implications on services from RCRP, reviewing AMHP capacity, and reprioritising funding to support s136 availability.

“In terms of the cost pressure, [area name removed] is currently evaluating the impact of RCRP on existing services and potential resourcing implications.”

In interviews, healthcare professionals explained that while no specific funding had been allocated to implement RCRP, money had been diverted from other budgets where possible; for example, one area reallocated funding from a staffing budget where the team was unable to fill vacancies. Interviewees expected a financial impact mostly around the utilisation of private services (such as private ambulances) and the employment of additional staff. Also raised in those interviews were staffing levels, with high vacancy rates and lack of out-of-hours capacity adding to pressures on ambulance, urgent care staff and AMHPs (Jefferson, et al., 2024).

Infrastructure

In June 2023, a minority of ICBs responded to DHSC’s survey that their HBPoS capacity was insufficient, either in general or at specific times. At certain points in time, HBPoS were said to be under more stress, for example at times of high demand or when problems in onward patient flow led to people being held for longer than necessary in HBPoS.

Responses from March 2024 indicate that this assessment has changed, with a slight majority now responding that their HBPoS does not meet their demand (60% of ICBs). The reasons behind strain on HBPoS did not differ between June 2023 and March 2024, with the availability of inpatient beds (86%), the volumes of s136 detentions locally (67%), damages to suites and the need for repairs (48%), as well as a reduced capacity due to the need to support children and young people (52%) all being selected as reasons for why their HBPoS does not meet demand, in March 2024.

In terms of supporting infrastructure, a few ICBs shared examples of new services and provisions that have been set up in their areas, such as rapid response vehicles, crisis cafes, and crisis line improvements, to help overcome infrastructure barriers from RCRP.

3.2.5 Risks

This section details a range of risks that were reported by respondents to the surveys and interviewees at the time that these research activities were carried out. The last subsection details ways that ICBs and LAs have been working with partners and will continue to work with them at a local level to overcome these issues and mitigate risks.

Staff and patient safety

Any safety incidents flagged by respondents are reports based on their perception of these situations at the time of the research. While it is out of scope for this evaluation to investigate individual incidents, areas should have escalation processes set up locally that can review cases and identify any changes in practice required to respond to similar situations in the future.

In June 2023, ICBs responding to a survey considered danger to staff and patients to be the most prominent risk of implementing RCRP. Regarding their staff, ICBs were concerned about situations where staff were required to support an individual and may be without police support to do so. Regarding patients, ICBs expressed worry about patients being left without a response from services, which might in turn increase their risk of harm. ICBs were also concerned that some patients might “fall through the cracks”.

In March 2024, as implementation progressed, the survey asked ICBs and LAs whether any incidents had occurred that they attributed to RCRP and which they felt had negatively affected the safety and wellbeing of their staff and patients. Over half of responding ICBs and over a third of responding LAs indicated that such incidents had occurred. When asked to provide more detail about any safety incidents or concerns, a few ICBs shared concerns that gaps in service provision created by RCRP, especially around services’ ability to respond to concern for welfare calls, may leave patients at risk. Detail was given in some responses about incidents that had impacted the safety of staff, as well as patients.

A few LAs also reported examples of instances that either led to harm to patients, or could have led to harm to patients, at risk to themselves or others. These were related to concern for welfare checks, patients leaving during MHA assessments, or in relation to responses where someone is AWOL from a ward. One LA also reported that their staff had experienced a negative impact when dealing with risky behaviour.

“There has been a negative impact upon our mental health care providers, when managing risky behaviour.”

In response to the same question, one ICB reported concerns about the impact of RCRP on children and young people when referencing a case where there was a delay in police response that could have led to harm to the child.

A few ICBs also reported incidents where they considered that police had not provided a sufficient response to episodes of violence or there had been a refusal from police to deploy where crimes were being committed. A few LAs also reported examples of the police not attending incidents where a crime was being committed. One ICB did suggest that these incidents were likely to be due to a misunderstanding of new protocols by their local police force.

“Supported accommodation providers for people with a mental health problem have reported instances where they have called for police assistance due to a crime being committed, such as an assault, damage to property or threatening behaviour, and the police redirecting to MH [mental health] crisis services instead.”

A few LAs did report examples where the police declined to deploy that may have contributed to harm to individuals. While it cannot be determined without further examination, it remains unclear whether these instances were to due police absence.

“Requests for welfare checks due to concerns about mental state of patient - police have declined to attend or have delayed attending and on 2 occasions the individual has later been found deceased. Other agencies do not have any power of entry so despite making visits over several days, they could not establish contact with the individual or properly check safety.”

ICBs and LAs also responded that they used their local partnership arrangements to work through adverse incidents and improve their response going forward; more detail on this can be found in section 3.2.6.

In interviews, healthcare professionals reported that partner agencies had different understandings of risks, organisational cultures and uses of language, which were seen as a risk to successful implementation. Some healthcare professionals who were interviewed expressed concern about the adequacy of the response patients would receive without the police attending. Some reported feeling undermined in fulfilling their duty of care, as they were unsure of whether a police response would be provided when needed. Regarding staff safety, interviewees mentioned that when called to visit someone in the community or in a place of residence, they reported sometimes feeling like they lacked protection and therefore felt at greater risk. A specific example of this was concerns from AMHPs about undertaking MHA assessments in the community, without police involvement, where a staff safety concern has been identified. Ambulance staff also highlighted that they may not be trained in the use of restraint or have adequate safety procedures in place when transporting patients without police accompaniment. To mitigate, health professionals have been exploring different ways to communicate the risks involved to escalate issues more effectively to police colleagues (Jefferson, et al., 2024).

Communication

In the early stages of RCRP (June 2023 DHSC survey), ICBs mentioned clarity and communication to be vital to rolling out RCRP. A breakdown in communication with partners was seen as a risk. Clarity was requested especially regarding timings, costs, and a national narrative on the programme.

At the time that the March 2024 survey was carried out, a few ICBs mentioned that there had been issues with communication at the national level and a lack of public communications, when asked to share their experiences of implementing RCRP in their local area, at the end of the survey, as well as issues with how RCRP has been communicated in the media. There was mention that negative communications from the media had not necessarily helped with the rollout.

A few ICBs also mentioned that there had been issues with communications at the local level from their local police force - one ICB specifically mentioned that “information sharing could be better where police are making changes or during decision-making processes.”

In interviews, healthcare professionals mentioned concerns about the future of their newly formed relationships. In some cases, trust between partners (from a health and social care perspective) had suffered from instances where the police declined to attend, leading to feelings of animosity. Interviewees explained that relationships “on the ground”, such as those of operational, patient-facing staff on the health and police sides, may develop differently and potentially deteriorate even though relationships at strategic and tactical level are successful (Jefferson, et al., 2024).

Roles and responsibilities

During the early stages of RCRP rollout, ICBs highlighted the need for the health sector to work collaboratively and build capacity across organisations to implement RCRP. Improved communication between mental health and urgent and emergency care teams was particularly relevant to responding ICBs. Respondents also said that to protect their working relationships in the future, they needed to foster collaboration and find a good balance between partners.

As rollout progressed, some ICBs (43% of respondents) had identified “a gap in service provision in the area” as a barrier to implementation. At the same time, “lack of clarity regarding responsibilities of agencies when responding to incidents” (71%) was also mentioned as a barrier, indicating that not all ICBs were able to prevent some of these early anticipated risks. On the other hand, only 3 ICBs (14%) did mention “multi-agency collaboration at local level not working well” as a barrier to implementation.

A few ICBs expressed concerns that misunderstandings and a lack of clarity of roles and responsibilities could lead to harm to patients and staff, with examples of some specific incidents shared. Most ICBs and LAs responded in March 2024 that their local police force was applying RCRP to children and young people for mental, as well as physical, health incidents. A smaller proportion of police forces were not planning to apply RCRP to children and young people at that moment but may do so in the future. However, some respondents from ICBs and LAs indicated that they did not know their police force’s position on applying RCRP to children and young people. Objectively, a lack of clarity might lead to adverse effects for children and young people. A few ICBs and LAs also shared worries that there seemed to be a lack of clarity about roles and responsibilities in relation to responding to concerns for welfare calls - it was mentioned that without this clarity, there would be a gap in services. This gap could exist where a call is received that does not involve an immediate risk of harm, criminality, or a health issue that would require a health response. Furthermore, it was suggested by a few ICBs that those services that were being expected to fill this gap would struggle to do so or may not necessarily be the appropriate agency for this issue. The researchers note that this could include incidents where the police are also not the appropriate agency for the issue.

“Significant concerns around the national gap that has been identified on Concern for Welfare…Where police forces are no longer responding to these calls there is a gap which will potentially lead to harm of individuals…”

“From [ambulance service name removed] there is a concern that the police will pass all health and social care related demands to [ambulance service name removed] even when [ambulance service name removed] may not be the appropriate agency, creating wider U[rgent and] E[mergency] C[are] system pressures.”

To address these issues, a few ICBs have worked with agencies to clarify roles and responsibilities across local partners - one ICB mentioned developing policies specific to certain phases, such as AWOL, to detail the roles and responsibilities of each agency.

“Development of [area name removed] AWOL policies to outline roles and responsibilities of respective partners, particularly for Mental Health Trusts.”

In interviews, healthcare professionals also raised questions around responsibilities and mentioned that, at times, there was confusion about legal frameworks, especially powers of entry and the most appropriate agency to respond to situations where the level of risk was hard to establish. Interviewees from ambulance services reported having been told they had powers to detain under s136 or had powers of entry to residences in case of mental distress by call handlers in some force control rooms. This is incorrect and led to confusion. Participants said that a lack of national guidance at the time meant that respondents developed very local approaches, with interviewees criticising the lack of clear communication and guidance to ensure equal levels of knowledge about RCRP. Participants said that a lack of clear guidance and clarity on thresholds meant that staff on the ground had to navigate these changes while each organisation was also experiencing individual constraints on capacity and capability, leading sometimes to delays in care (Jefferson, et al., 2024).

Speed of rollout

When asked about barriers to implementation in March 2024, more than half of responding ICBs (57%) and LAs (64%) responded time pressure to implement.

When asked, in general, about their experience of implementing RCRP, a few ICBs mentioned that they felt time pressured to move forward with each phase. One ICB also mentioned that the lack of system capacity was making it harder to move forward under the time pressure. Another mentioned that the timescales “do not allow sufficient time for review and lessons to be learnt before implementation of next phase”. One ICB also mentioned that the time pressure was coming from the police in their local area, who were pushing forward on RCRP approaches before other systems were ready for change. One LA also referenced time pressure in their local area as an issue.

“The biggest issue is lack of system capacity to take this forward at the pace required.”

This point is echoed in interviews where healthcare professionals highlighted the speed of implementation posing challenges. Senior health leaders were said to have given “robust feedback” which then led to softer transitions. It was said that time was crucial to understand the scale and challenges for partners during the implementation process (Jefferson, et al., 2024).

3.2.6 Local risk management

In interviews, some healthcare professionals explained that uncertainty was caused where local police resources, for example control room toolkits, were not shared with partners.

In March 2024, over half of responding ICBs stated that they had a multi-agency real-time escalation protocol (54%) in place with a similar proportion of ICBs saying they had a retrospective escalation protocol in place (46%) and several saying that they were developing said protocols (43%). Similarly, over half of LAs had multi-agency real-time escalation protocols established (53%), some also had retrospective ones (21%), and several were developing protocols (29%). A few participants had neither type of protocol in place (3% of ICBs and 12% of LAs). LAs were also asked about strategies to learn from adverse incidents, with just under a quarter of respondents stating they had a strategy in place (23%) and a third currently developing one (31%). Only a few LAs had, at that point in time, established strategies to share their learning more widely.

Examples shared by several LAs included an escalation flowchart developed by their local police force, an escalation matrix, and an adult social care checklist that included an escalation procedure. Following escalation protocols, such as escalating to police contacts for support, has helped resolve local incidents, as shared by a few LAs. Examples given by a few ICBs include having a nominated police liaison officer and holding monthly tactical meetings with partners to review cases.

As part of local risk management associated with RCRP implementation, a few ICBs and LAs mentioned that they have reviewed cases with partner agencies, such as the police, and have made use of multi-agency meetings to discuss these incidents. These review processes have provided ICBs and partners with the opportunity to learn from incidents by particularly focusing on system improvement, learning, and prevention.

“…Each case study is resolved individually, and we explore and implement ways to prevent further issues.”

“A multi-agency tactical review group meets weekly to review where there is learning and any changes which need to be made.”

Overcoming barriers associated with local risk management has involved working with partners to develop effective escalation processes for incidents, as mentioned by a few ICBs and LAs. Several ICBs mentioned that they had shared the escalation protocols they use with agencies such as the police, to help align processes. A few ICBs mentioned that processes have been agreed with all partners to help with the resolution of issues. A few LAs also mentioned that cases have been resolved through partnership working.

“This has included effective escalation and police engagement/partnership meetings and deep dives into specific incidences. This has significantly contributed to the smooth transition to RCRP despite the challenges.”

Overall, a few ICBs and LAs discussed how sharing learning through collaboration and discussion between partners and across England has aided RCRP implementation. For example, a few ICBs mentioned that a few incidents where originally there was not a sufficient police response were resolved by engaging with police and reviewing policies and procedures at the local level.

“We’ve had instances whereby services have carried out due diligence in relation to RCRP where the outcome was that police intervention was needed and police have not responded. As we have good working relationships with our local constabulary, we have been able to resolve these on a case-by-case basis.”

“There will continue to be development opportunities for the ICB and our partners especially around case reviews and ensuring that everyone is well engaged in the steering of NPA:RCRP across our region. Key to our success is the openness for collaboration and learning.”

3.2.7 Perceived impacts

Demand

In March 2024, ICBs and LAs were asked about whether they expected the impacts of RCRP to increase demand for their services. None of the ICBs expected to experience less demand on their services due to RCRP.

Across the board, ICBs and LAs predominantly expect to see moderately more demand on health and social care services. At least 35% of ICBs consider each of the following services will experience more demand: mental health crisis teams, mental health crisis lines/ NHSE 111 mental health option and ambulances. At least 30% of LAs consider significantly more demand could be placed on mental health crisis lines/ NHSE 111 mental health option, urgent and emergency care, and ambulance services.

S136 handovers

ICBs highlighted potential barriers to implementing reduced s136 handover times and the mitigations needed. These include:

system flow issues, such as the availability of inpatient beds to accommodate patients after handover, or the availability of social care staff alongside the handover process
the need to manage specific risks regarding s136 handovers - ICBs explained that colleagues at HBPoS are sometimes asking policing colleagues to stay longer until they are confident to manage the patient, this is more likely when patient data is unavailable, making risk assessment difficult; it has been highlighted that EDs are less likely able to handle high-risk patients but are sometimes used when dedicated HBPoS are at capacity, or where they are the most appropriate place for a person to be, for example in cases of physical injury or overdose
the need for a stronger, shared oversight of the process - this would include an improved understanding of responsibilities between each involved agency, training police officers to understand the appropriateness of s136 detentions and training healthcare staff to better assess risks
an increased workforce, with more staff trained to manage people in a crisis, including more staff trained in restraining patients, when necessary, especially in EDs, to allow a quicker handover process between police and healthcare staff - there is also a need for increased capacity across certain professions, such as s12 doctors and AMHPs
a better HBPoS infrastructure to minimise wait times and help to avoid the use of EDs - in March 2024, nearly half of ICBs who responded that they would need additional HBPoS infrastructure reported that they would need one more facility

When asked in 2023 about implementation timelines for a reduced s136 handover, the assessments of ICBs varied, with the majority estimating more than a year was needed. In 2024, less than a year later, fewer than 20 of the 35 responding ICBs had either implemented this phase of RCRP or had a mutually agreed date for implementation. When asked what proportion of handovers were currently achieved within one hour, we received some responses with proportions ranging from 47% to 78%.

A mental health system under strain

In interviews, participants expressed concern about the system’s ability to sustain the changes brought about by RCRP given the existing challenges regarding resource. Interviewees said they had to balance the remit of their care with perceived additional expectations on their staff. At times this leads to increased reliance on the VCFSE sector or non-clinical staff being involved in providing support even though they might not be appropriately trained. Participants worry that their lack of capacity to respond and the absence of police involvement might negatively impact their professional duty of care and ultimately the patients (Jefferson, et al., 2024).

3.3 Fire

3.3.1 Findings

To gain a better understanding of RCRP implementation from the perspective of FRSs, 3 FRS leads were interviewed. These leads were based in the same 3 policing areas as the police evaluation and monitoring research where the police had either implemented or were in the process of implementing RCRP. The findings presented reflect qualitative perceptions and experiences of participants involved in the research. Quotes and extracts from their interviews are included to illustrate participants’ views and provide early insights of perceived impacts. It is important to note that these are not quantitatively measured impacts.

3.3.2 Knowledge of RCRP

FRS participants were confident in their understanding of the purpose of RCRP. They explained clearly that RCRP aims to direct the best and most appropriate care to those in need.

FRS participants discussed their statutory duties under the Fire and Rescue Services Act 2004 (FRSA). They explained RCRP implementation should not affect their role as the incidents that police were stepping back from are typically outside of FRS’ professional remit, except where they have a memorandum of understanding (MoU) or tripartite agreement with other services. Participants were conscious that FRS should not be filling a gap in service, but they would attend calls if it was a statutory duty, to support at incidents, or to gain entry to a property on behalf of their local ambulance service in line with an agreed MoU. They also identified that call operators mobilising firefighters and duty managers have individual discretion in deciding whether they attend incidents that fall outside their statutory duties. Participants observed that attendance at mental health calls that do not meet the RCRP threshold is the role of health or social care teams.

3.3.3 Legal responsibilities of police and fire services

FRS participants discussed the legal responsibilities of police forces and fire services, particularly relating to attendance at incidents and their powers of entry. There was some awareness of police powers under Articles 2 and 3 of the ECHR and FRS participants discussed the conditions under which police will deploy on that basis. One participant was not aware of the specific articles within the ECHR but understood that there was legislation permitting police the power to enter a property under certain conditions. One participant was aware of the powers police officers had regarding patients under s136 of the MHA.

Participants added that police forces had communicated information about their powers during the first early engagement meetings the police had hosted for all relevant stakeholders. FRS participants highlighted the FRSA as the legislation which sets out the criteria for them to enter a premises, which includes gaining entry in the event of a fire, to effect rescue, or to gain access to contaminated water supplies. They each identified that their FRS had an agreement (MoU or tripartite agreement) with either the ambulance service, or both police and ambulance services, to help gain entry to properties. It was noted that, during FRS engagement with the police on RCRP, there was a misunderstanding of FRS statutory powers to gain entry under the FRSA. It was suggested that the duties FRS perform under the MoU with the ambulance service to gain entry may have been misinterpreted as a statutory duty. Concerns were raised over how the FRS sometimes use devolved powers through the police (using an MoU) to gain entry at some incidents for the ambulance service. There is a concern that if the ambulance service does not have the capacity and resource to take on higher demand of mental health and other welfare incidents, police forces may try to bypass the MoU and go directly to the FRSs to perform those duties, which they would usually only complete for the ambulance service.

“The [local] police when drafting a MOU with [local] fire services tried to use the FRS Act and say that we had powers of entry. But actually, if you pick up the Act and look at it, it’s not entry for no particular reason. You’ve got to believe that a fire is broken out or gain entry to affect a rescue where somebody’s life is in danger. It doesn’t cover us for just going in because [of] a potential [risk].”

FRS, 2

3.3.4 Application of RCRP

Participants discussed the differences between phased and full implementation of the RCRP approach, giving recommendations on lessons learnt and some advice on best practice for future implementation in other FRS areas. While one participant was not aware of the different phases of the RCRP implementation, generally participants identified the phased approach to be beneficial. This enabled them to learn from each phase and both themselves and partners had time to identify gaps as well as ensuring policies, systems, processes, training, and support were in place. It was noted that the police were flexible with timescales and only implemented the next phase when partners were happy with the approach.

“But by phasing it, and they weren’t precious about the timescales, they [said] we’ll go to phase 2 when we’re happy phase 1 is sorted. It [wasn’t], you’ve got 8 weeks and that’s it, and we’re going with phase 2, and then 8 weeks we’re going with phase 3. It was when everybody’s happy.”

FRS, 1

FRS interviewees said that through planning and implementation of RCRP, lessons have been learnt about good practice and the benefits of RCRP. It was noted that the time between the initial meeting with police informing FRS about RCRP and implementation could have been longer to allow stakeholders more time to conduct a gap analysis, and to consider and prepare for any impact. Participants noted that good practice involved having strategic and tactical groups with all partners present before, during, and after implementation. They added that it was helpful for the police to share training materials for a standardised message across all fire services.

3.3.5 Engagement with partners

Participants discussed both early and ongoing engagement with relevant partners including police forces, ambulance services, healthcare professionals, National Fire Chiefs Council (NFCC), and other stakeholders. All participants had some engagement with the police before the implementation of RCRP. It was mentioned by 2 respondents that police had facilitated several workshops involving practitioners - one of these respondents said the workshops were facilitated with the mindset of putting the onus back onto statutory duty holders and addressing their concerns and issues. Following their early engagement meetings, representatives from FRSs were invited to both tactical meetings and strategic meetings, or regular meetings, with the police to discuss the police’s statistics and incidents. Positive engagement was identified in these groups due to the discussion and evaluation of their response to real-life examples of calls with all attendees. It was noted in one case that the ambulance service was only introduced at the fire representative’s suggestion.

“What we’ve done with our safeguarding officers is ensured that we’ve got contacts through the [FRS area] LA around adult social care, children’s social care and out of hours, making sure they’ve got the contacts and emails and things.”

FRS, 1

Participants also discussed positive engagement between FRS and other stakeholders, including social care and LAs. In the early stages of RCRP implementation, there was contact with the NFCC, FRS representatives and neighbouring FRSs. Participants found engagement with neighbouring FRSs useful as they could discuss how they found the implementation and whether they had any issues. One participant expressed their interest in examining the impact on the community during engagement meetings, and that it would be helpful if the public were aware of RCRP.

“We were invited in the very, very early days of the inception of this to those tactical and strategic level meetings. And before that, they’d actually facilitated a number of workshops involving practitioners (…) I would be very, very complimentary of the police in [force area] because they did that a long, long time ago with the view and the mindset of putting the onus and the emphasis back onto those statutory duty holders to say we’re giving you enough time now in the lead up to [implementation date] to start putting your own issues and your own concerns into place.”

FRS, 3

3.3.6 Training for RCRP

Fire services delivered training on the RCRP approach in a range of ways to different members of their teams. Two participants said they provided awareness training for the police’s role in RCRP. Participants reported the positive impact of receiving information and materials from police colleagues, which included a short educational video about RCRP to share amongst FRS colleagues. Another participant noted their FRS had received RCRP poster materials from the police. They reported that training sessions had also been delivered to middle managers around the police’s role. However, one participant also reported that they created their own training materials as they did not receive any materials from police colleagues.

3.3.7 Impact of RCRP

Participants discussed the impact RCRP has had on their service and the effect it could cause in the future, if there are any changes within their service. All participants thought that RCRP has had no or minimal impact on their FRS.

However, one participant also noted that their FRS was being requested to attend incidents and assist ambulance staff more often, due to RCRP, while another participant said that this had started prior to the implementation of RCRP. They added that the ambulance service may be receiving more calls to attend incidents and are passing these to FRS by finding innovative ways of securing FRS attendance. Two participants identified that they have received calls where they were unlikely to be needed.

“What I think we have found is that ambulance are receiving more calls to actually go and attend these incidents and they’re passing them on to us. And if I’m honest, probably finding some very innovative ways of getting us to go where maybe we wouldn’t usually.”

FRS, 2

“So obviously when we’re saying time critical, of course we’ll come up [to help the ambulance service] if it’s an emergency. And what we then find is the ambulance control will call back 10 minutes later and say, oh, actually now the person’s gone time critical. And when we get there quite often we get to the calls and we find the ambulance crew still sitting outside in the ambulance and haven’t even gone and tried the door.”

FRS, 2

Participants said that expected/potential changes around the role of the fire service could have an impact. All participants suggested ways that the firefighter role may change in the future and that their capabilities could potentially expand. This was particularly related to extending to incidents that are currently in the remit of the ambulance service. Participants said they anticipated the impact on the healthcare sector, including mental health services, health, ambulance, and social services, to be larger than the impact for FRS.

“I think if we were to go down the route of co-responding… we might find that we can potentially deal with some of these calls, even though I’d be slightly wary of having the right mental health training, but I think we’ll find that we will be called to more of these because we will be going to those category one calls for ambulance as opposed to the calls that we go to at the moment.”

FRS, 2

“Most ambulance services have got elongated attendance times for certain incidents because they’re getting held up with discharging patients into the hospital system. What we’re very, very keen to avoid doing is making sure that we then don’t end up tying up fire resources in the long term, looking after patients where we’re not able then to respond to operational incidents ourselves.”

FRS, 3

Question 5

4.  Discussion

Accepted Answer

Research findings from the HO and DHSC have been synthesised in the following discussion. Following the publication of the NPA, guidance documents and toolkits, along with the other supporting activities carried out by partners outlined in section 1.2, this evaluation aimed to understand whether RCRP was being implemented as planned. It also aimed to identify any barriers to implementation across forces, health, and social care, and lessons learnt on the ground from policing and health partners. Findings were fed into the system in real time to support and enhance activity as RCRP rolled out. While this research was taking place some of the identified good practices, barriers, challenges and potential gaps in service were also identified at a national level. As implementation of the RCRP approach progressed, actions have been taken to address any risks.

4.1 Good practices in implementation

What worked well and which factors contributed to the successful implementation of the RCRP approach?

4.1.1 Communication and engagement

Participants from police, health, social care, and FRS agreed that communication played a crucial role in implementing RCRP. From a policing perspective, communication through the RCRP approach has been good. Engagement with partners has worked well and has increased since RCRP has been introduced. Initial concerns raised by some partners, for example around the timing of implementation, have been able to be addressed through engagement with those partners. Awareness of partners’ legal responsibilities, and the expectations for safeguarding and duty of care, have been clarified, where needed. Review and escalation processes have been established, or clarified if already in place, to share concerns and/or good practice. Policing leads and operational police staff also identified the positive engagement they had with the public when applying RCRP, as well as positive reactions from the public who understood and accepted why the police should not attend certain incidents.

For ICBs and LAs, good communication and engagement with partners, especially on issues such as governance, structure, roles and responsibilities, and escalation processes, was key to successful implementation of RCRP in the health and social care system.

The statutory duties and legal powers of FRS have been clarified with partners through communication and engagement. Where a MoU or tripartite agreement is in place with police and ambulance services, they have worked well to improve understanding of the FRS role in RCRP.

Police, health, and social care representatives valued information and knowledge sharing. Information and knowledge have been shared across police forces, and through policing bodies such as the NPCC and CoP, which has helped forces develop their RCRP plans and approach to implementation. Sharing information with partners has improved understanding of RCRP and partners’ responsibilities.

ICB and LA representatives reported that sharing learning across partners, both in the healthcare system and with other agencies, contributed to a smoother implementation of RCRP for ICBs and LAs. This was predominantly done through discussing issues at multi-agency meetings dedicated to RCRP.

4.1.3 Multi-partner working

Respondents from police, health and social care spoke positively about working together, although some challenges remain. When planning for RCRP, early engagement with partners and bringing multiple partners into discussions helped police forces to understand their workload and demand requirements. Police forces engaged with a range of partners during the strategic planning for RCRP, including health and services, LAs, FRS, coroners, and representatives from the VCFSE sector.

For the majority of ICBs and LAs, positive partnership working and building strong relationships with key agencies, such as the police, has contributed significantly to a more positive experience of implementing RCRP. This has often been achieved by ensuring early on that any multi-agency groups or meetings had good representation of different agencies.

4.1.4 Regular discussions

Participants from police, health and social care highlighted the value of regular conversations. Police forces recognised that having regular meetings, being open and transparent with partners, and listening and responding to concerns raised, helped alleviate partners’ concerns around RCRP.

Meeting regularly with agencies to discuss developments and issues, such as timelines, resources, and roles and responsibilities, was an example of good practice that was frequently raised by ICBs and LAs. This helped ensure that RCRP was implemented as smoothly as possible.

4.1.5 RCRP phased approach

Participants from police and FRS highlighted that a phased approach to RCRP implementation represented good practice. A phased approach was noted as allowing for an increase in partners’ awareness and preparation, and for the possibility that lessons can be learnt from each phase that can inform later phases.

4.1.6 Monitoring and review of RCRP

Collaboratively monitoring and reviewing RCRP was mentioned by both police, and health and social care, as an important aspect of implementation. Police reported they were sharing information from reviews with partners, including any deployment errors that had been identified, and they were learning from their review processes. Police staff reported that when RCRP incidents and decisions were included in a coroner’s feedback to them about a case, RCRP was reviewed to ensure it was being implemented correctly.

An important part of ensuring that RCRP was implemented as smoothly as possible in the health system was ensuring that effective safety protocols were established to allow staff to escalate any issues that were putting patients and staff at risk. ICBs and LAs have worked with partners or are currently in the process of developing with their partners efficient safety protocols that provide them with opportunities to review any flagged cases and establish processes to learn from incidents, including both real-time and retrospective escalation protocols.

4.1.7 Single points of contact (SPOC)

SPOCs were helpful at various levels across police, health and social care. It was noted that having a SPOC with partners at a tactical/operational level allowed for better communication and decision making between partners.

A specific part of real-time escalation protocols that was established by many ICBs and LAs was having a SPOC, often in their local police force, to escalate issues to. Respondents said this was a good solution to easily flag safety incidents in real time.

4.1.8 Training

Findings highlighted the importance of adequate training for police staff who make decisions on RCRP. Good practices were viewed as having toolkits for decision making, floorwalkers and mental health advisors in control rooms, and refresher training. Easy access to immediate and slower time escalation processes, where deployment decisions are unclear or disputed, will contribute to successful implementation. Police survey responses showed that nearly all control room staff in the sample had received RCRP training and the majority of these respondents were satisfied with the training.

4.1.9 Data monitoring

Police reported the importance of data collection and monitoring to inform where policing demand falls for RCRP type incidents. Having analysts and automated tools to complete the work was seen as good practice.

4.2 Partnership working

Has partnership working improved because of implementing RCRP?

Overall, respondents to our research indicated that there has been better collaborative partnership working. Where there is good communication and wide-ranging involvement of partners, relationships have improved.

Police recognised that improved partnership working has resulted from having:

more transparency, better communication and understanding of partners’ processes and their legal responsibilities
strategic and tactical groups to share information, for escalation of concerns, and for sharing feedback on processes
engagement with a wider range of partners, including but not limited to PCCs, FRS, mental health crisis teams, the VCFSE sector, and DWP

FRS also identified these improvements in partnership working and thought the phased approach had worked well as regards the sharing of learning after each phase.

Collaborative working was often cited by both ICBs and LAs as something that has been a positive experience, with several mentioning that RCRP has provided an opportunity for better joined up working with other agencies to learn more about their roles and responsibilities. ICBs and LAs frequently shared positive feedback for the police, including how they have experienced good collaboration with their local police forces and how their police forces are open to learning from safety incidents.

However, some challenges remain. At operational levels in policing, there are some practical limitations for implementing RCRP, such as when making decisions that can be difficult for partners to deliver due to funding or resourcing constraints. There were times when some partners, particularly some LAs and social services, did not respond to communication from the police, including inadequate engagement at strategic partnership meetings, which made it difficult to discuss implementation. Difficulties at an operational level also included the flow of information from strategic to tactical levels in partner organisations, which, at times, appeared to be limited.

Likewise, while many ICBs and LAs cited positive partnership working, this experience was not universal across those implementing RCRP. Specifically, a few LAs experienced inefficient collaboration with their partners and flagged that they felt that implementation was being driven by the police and ICBs, with LAs not necessarily having an equal role in decision making. Some DHSC survey respondents indicated that not all partner agencies were equally represented in some partnerships.

While communication and information were not flagged as major barriers in surveys by ICBs and LAs, a few ICBs mentioned that communications at the local level from their police force, specifically around information sharing during police decision-making processes, had been a challenge for them.

Even though many agencies were well represented in partnerships for RCRP, at the time this research was conducted, participants noted several stakeholders that are less widely included such as services for children and young people, VCFSE organisations, people with lived experiences or NHSE-led MHLDA provider collaboratives. Not including these organisations in local partnerships could pose challenges later for RCRP implementation if they are not being sufficiently consulted.

4.3 Barriers to implementation

What have been the main barriers to RCRP implementation?

4.3.1 Capacity and resourcing limitations

The main barrier to RCRP implementation was identified as capacity and resourcing limitations within health and social care for responding to incidents that had been dealt with by the police before introducing RCRP. Absorbing this demand has been made more challenging by wider increases in demand for health and social care services and ongoing resource challenges in many ICBs and LAs. Despite this, a few ICBs have been able to overcome this barrier by making use of third sector organisations, using 24/7 mental health lines, and recruiting more staff to EDs.

These resourcing and capacity issues were recognised at operational and strategic levels in policing. They understood that partners’ ability to accept their duty of care can be reduced, but this can lead to police taking responsibility for incidents and inconsistency with their decision making; for example, deployment to incidents where there is no availability or slower response times from ambulance services.

4.3.2 Cost and funding pressures

Another significant challenge facing ICBs and LAs was the lack of additional funding being supplied to the healthcare system. Without this additional funding, it has been a challenge for the system to move forward with implementing RCRP and will make it difficult for health and social care services to meet the demand that was being dealt with by the police, prior to RCRP. A few ICBs have been able to overcome this barrier by diverting money from other services where possible. Many are evaluating the cost pressure they are facing and the implications on services.

4.4 Unintended consequences, risks, and learning

Which unintended consequences or risks have been identified and what can be learnt from these?

4.4.1 Gaps in service

ICBs and LAs have been concerned about potential gaps in services that are materialising. These gaps were often cited as being related to a lack of clarity around roles and responsibilities of agencies and who should respond to certain calls, resulting in either a refusal to deploy by the police or a delayed response. This has created a significant challenge to the smooth implementation of RCRP and respondents voiced concerns on the potential impact on vulnerable patients. A gap identified related to concern for welfare incidents where there is no immediate risk of serious harm, criminality, a health issue that the ambulance service would respond to, or any other safeguarding matter. Both ICBs and LAs have reported that this gap could potentially lead to harm to patients. The lack of clarity around who should respond to those types of concerns for welfare calls was cited many times as a significant risk, with some saying that there was potential for this to lead to harm if a call about a patient is not picked up by a service. This challenge is further exacerbated by ICBs and LAs feeling under pressure to move forward with implementation, with some saying the pressure is coming from their police force.

For the police, they recognised that gaps in service may exist where partners are not able to respond. These can be when police receive reports of suicidal ideation but there is no immediate risk to life and no other partners are available to assist, or when a decision is made not to attend a welfare check, but the call is not for partners either. Establishing responsibility for incidents that are not always clear cut, and where partners have no capacity to deal with it, can lead to decisions being made that are not in line with RCRP guidance, such as police deploying to incidents that are not appropriate for them.

FRS noted that the speed of implementation led to a lack of opportunity for FRS gap analysis (comparing actual performance with anticipated performance, considering any potential gaps in resource or skill and enabling solutions to be developed). FRS may be called up to deal with incidents, particularly where access to properties is needed, when partners do not have the resources to attend and the police threshold for attendance has not been met. Some misunderstanding was also identified around FRS powers and their statutory duties; FRS raised concerns about how the police sometimes inappropriately called upon them to exercise their powers to gain entry on behalf of the ambulance service.

The concerns around gaps in service were fed into the system at a national level in real time to support and enhance activity as RCRP was being rolled out. Where gaps in service had been identified, actions have been taken to address any potential risk through partnership communications and escalation routes.

4.4.2 Imprecise reporting of incidents

Operational and strategic police staff were concerned that the ambulance service was making some calls to the police that appeared to adapt the information provided so as to find loopholes in RCRP guidance and ensure the police would attend. Police staff suggested this may be due to a lack of ambulance service resources or capacity to deal with the incident themselves. FRS also noted that the ambulance service was calling them and finding innovative ways to ensure an FRS response to incidents. Ensuring staff obtain accurate incident details is crucial for staff in police, fire, and ambulance call centres, and accurately sharing the information with partners is vital for decisions to be made on the best response for the caller.

4.4.3 Consistency of approach

From the health and social care perspective, there was a feeling that there was not necessarily a consistent approach to certain call types. Participants reported incidents where it was perceived that the police did not sufficiently respond to episodes of violence or there was a refusal from police to deploy where crimes were being committed. The Independent Office for Police Conduct (IOPC) position statement (IOPC, 2024) states that police leaders and those in health and justice systems must work together to improve frontline health support. Inconsistencies may arise if call handling scripts or toolkits for RCRP oversimplify these types of calls and call handlers do not collect all the possible information, such as the person’s previous history of contact with the police.

Police recognised that inconsistency with decision making can impact RCRP, but decision making can be difficult for control room staff. Incidents are often not clear cut, and their decisions are based on the information they are provided with, which can be incomplete. The police also identified that with the phased approach of RCRP, phase 1 decision making may have been applied to incidents that would be covered in phase 2 or 3, such as walkout from healthcare, before these phases had been implemented meaning partners are not ready for dealing with these incidents. These areas may be difficult to clarify and, if they are not addressed, an inconsistent approach to deployment may result. Guidance for police and other professionals has been provided by national bodies (as outlined in section 1.2.1, but some was published after this research was undertaken), which will aim to help provide a consistent approach.

4.4.4 Additional risks identified

Senior and operational police staff noted that when the police are collecting and reporting information on implementing RCRP and its impact, there may be a focus on police demand savings, and it is difficult to measure the impact of RCRP for the public and service users in relation to the aims of RCRP - ensuring the public received the right care when they call for assistance. They added that if public perceptions are that the police will not be dealing with certain types of calls, the public may not call the police, and they may also not know who to call when help is needed - therefore education for the public around partner agency responsibilities would be beneficial.

The application of RCRP to children differs between areas and some ICBs and LAs reported being unsure what their police force’s position on this is, potentially putting children and young people at risk. Additional guidance relating to children has been published since this research was conducted, which should significantly reduce this risk.

4.4.5 Adverse outcomes or unintended consequences

LAs and ICBs were asked in the survey if there had been any safety incidents which negatively affected patients or staff that they thought were related to RCRP implementation. Any safety incidents flagged by respondents are reports based on their perception of these situations. While it is out of scope for this evaluation to investigate individual incidents, areas should have escalation processes set up locally that can review cases and identify any changes in practice required to respond to similar situations in the future. Both ICBs and LAs flagged several incidents they perceived were due to RCRP, which had resulted in patients experiencing some form of negative impact and, in some cases, they felt had put staff in harm’s way. Some of these incidents were reported to be due to a lack of clarity regarding who should respond to certain types of calls, especially around concern for welfare calls. The NPA sets out that partners should work out and agree such issues prior to going live. Further, local escalation routes should be used when determining specific cases, with feedback loops in place for further learning. Responses from ICBs and LAs highlighted that the majority have escalation routes in place with local partners, or they were under development at the time of research, with specific examples given of these routes and how they had been used to resolve incidents. There were references to a lack of response or a delay to the response from the police where respondents reported a crime was being committed.

The police noted that there may be an adverse outcome where policing deployment decisions are made in line with guidance and in good faith. Case reviews will be undertaken to assess if lessons need to be learnt or policies amended. Healthcare providers and LAs reported that they have been working with police colleagues and other agencies to resolve the safety incidents previously mentioned by reviewing cases and taking learning away to prevent further incidents.

4.5 Early impacts of RCRP

What are the perceived and quantified early impacts of RCRP?

4.5.1 Actual and perceived demand on services

Police participants reported a perceived reduction in officer time spent dealing with RCRP incidents, with a perceived reduction in calls for assistance from partners. These perceptions are supported by analysis of incident data gathered from a sample of forces. Findings from the early quantitative data monitoring indicated savings of police time for all the forces included in the sample. This analysis found that following the implementation of RCRP each force sampled observed a reduction in the number of CfS incidents received each month and a reduction in the number of these incidents that officers were deployed to each month. For several forces in the sample, where the number of CfS calls has declined, the rate of deployment to these incidents has increased. This may indicate that implementing RCRP has led to some change in those contacting the police, as the number of these incidents being received by forces has decreased. This lower number of incidents also seems to have led to an (anticipated) increase in deployment, which suggests that the incidents that are being reported are more often those that require police attendance.

The amount of time saved as a result of these reductions was estimated for each force and was found to be equivalent to multiple FTE officers working for a month, or, in one case, over a hundred FTE officers working for a month, although the size of the force will be an inevitable factor affecting the data. Should other forces realise these time savings, this would be a considerable resource, enabling this time to be spent elsewhere and focused on key policing responsibilities (although how this time is spent is beyond the scope of this evaluation). The findings and estimations from this analysis suggest that police forces have observed a reduction in demand, and time spent on certain incident types, following the implementation of RCRP.

Respondents from health and social care expect demand for services to increase, especially for mental health crisis teams, mental health crisis lines (including the NHSE 111 mental health option), ambulance services, and urgent and emergency care. However, any anticipated increase in demand on health and social care services arising from RCRP has not been quantified in this evaluation, and the expected demand is based on perceptions of the research participants.

Healthcare providers also flagged that they were generally concerned about the system’s capacity to successfully take on the hidden demand that RCRP will direct back to them without detriment to other services.

FRS interviewees mentioned there has been little or no impact on FRS, but if there are changes to FRS roles and workload these could have an impact in the future.

4.5.2 Additional perceived impacts for policing

Police participants perceive that their workload and the number of calls for service are more manageable as a result of RCRP, with the public receiving a better service, as partners and the police have more capacity to deal with the incidents they are trained and responsible for. Police participants noted that call durations were becoming shorter as call handlers were using structured sets of questions and toolkits to make quicker, more efficient decisions. A positive perceived impact was also noted on the length of time that incidents were open and awaiting officer deployment, leading to fewer complaints about wait times for contact from officers. Operational police staff noted that frontline officers’ reactions to RCRP were positive, and officers were coping better with their workload.

Policing leads and operational staff reported having a good understanding of RCRP. Police call handlers are more aware and confident in their legal responsibilities when making decisions. RCRP had also given them more confidence to challenge whether police involvement is needed. There has also been an increase in partners’ understanding of RCRP and the legislation relating to thresholds for police attendance, the police’s legal responsibilities, and police and FRS powers.

4.5.3 Limitations and continued guidance

Government social researchers conducted the HO process evaluation. Participants were advised of this and the purpose of the research prior to the interviews and observations. The researchers have presented thorough findings, with a balance of views of RCRP implementation from participants. This rapid evaluation was conducted in areas where RCRP had been implemented to provide an early assessment of RCRP implementation.

RCRP continues to be rolled out by forces independently with their own timescales. Guidance and training packages have been provided for RCRP implementation, with continued advice being provided by national bodies, for example, through the NPCC, CoP and NHSE. Further research examining the impact of RCRP for partners and service users would be of value.

The research activities conducted by DHSC for this process evaluation did not include the collection, nor quantitative analysis, of health and social care monitoring data. Therefore, the perceived positive or negative impacts to the health and social care systems cannot be quantified to balance with the quantifiable findings of police hours saved included in the HO process evaluation.

Question 6

5.  Conclusion

Accepted Answer

This evaluation was conducted to understand how RCRP is being implemented. To represent the wide range of stakeholder perspectives, researchers from the HO and DHSC collaboratively designed a rapid process evaluation covering police, fire, health and social care. This evaluation comprises qualitative and quantitative evidence gathered through interviews, surveys and monitoring data. All research took place between autumn 2023 and spring 2024.

The research finds that:

communication was perceived as crucial to successful implementation - partners highlighted the importance of early and wide engagement and regular meetings with all stakeholders
openness and transparency led to trusting relationships - inefficient collaboration hindered partnership working, especially when stakeholders felt out of the loop or lacked agency
while health and social care organisations agreed with RCRP in principle, an expected increase in demand and a lack of resources across health and social care will present challenges to their implementation - police forces often understood this challenge and tried to find viable solutions together with partners
police and health and social care participants expressed concern about potential gaps in services, a lack of clarity around roles and responsibilities, pressures to implement at pace, and inconsistent decision making, all of which could lead to adverse incidents
RCRP has led to a reduction of police time spent on health incidents, allowing the police to devote more time to other tasks - respondents from health and social care perceive an increase in demands on their services, but this has not been assessed through quantitative analysis in this evaluation

Best practice identified from the research:

the establishment of multi-agency ways of working, including regular meetings to discuss timelines, resources, roles and responsibilities and documents such as memoranda of understanding and tripartite agreements
active sharing of learning and best practice within organisations and between partners
the provision of adequate training to ensure all staff in all agencies are aware of legal responsibilities and guidelines
the development of effective safety protocols and real-time and retrospective escalation protocols - SPOCs were deemed very helpful in facilitating communication
a phased approach which allows for an incremental shift in practice and enables learning between phases

As RCRP implementation progresses, HO and DHSC encourage all multi-agency partnerships to collaboratively assess their implementation process and monitor impacts on their local population.

Question 7

References

Accepted Answer

ADCS (2024) Right Care Right Person for children - implementation principles. Available online [accessed 21/10/2024].

APCC (2024) Association of Police and Crime Commissioners Guidance: Right Care, Right Person, and the National Partnership Agreement. Available online [accessed 18/10/2024].

Brooks, J., & King, N. (2014) Doing template analysis: evaluating an end of life care service. Sage Research methods cases.

Buckley, S. (n.d.) ‘Does having a mental health problem make you violent?’ Available online[accessed 18/10/2024].

CoP (2023a) Right Care Right Person toolkit. Available online [accessed 18/10/2024].
CoP (2023b) Right Care Right Person - Humberside Police smarter practice. Available online [accessed 21/10/2024].

CoP (2023c) Right Care Right Person - baselining criteria. Available online [accessed 21/10/2024].

CoP (2023d) Right Care Right Person national guidance launched. Available online [accessed 21/10/2024].

CoP (2024) Right Care Right Person - Implementation principles for incidents involving children. Available online [accessed 21/10/2024].

Darzi (2024) Independent Investigation of the National Health Service in England. Available online [accessed 21/10/2024].

DfE (2023) Working together to safeguard children. Available online [accessed 21/10/2024].

DHSC (2018) Modernising the Mental Health Act - final report from the independent review. Available online [accessed 18/10/2024].

DHSC & HO (2014) Mental Health crisis care agreement. Available online at ‘Mental Health Crisis Care Concordat Improving outcomes for people experiencing mental health crisis’ [accessed 18/10/2024].

DHSC & MoJ (2022) Draft Mental Health Bill 2022. Available online [accessed 18/10/2024].

GOV.UK (2020) Magenta book: Central government guidance on evaluation. Available online [accessed 21/10/2024].

GOV.UK (2023a) National Partnership Agreement: Right Care, Right Person (RCRP). Available online [accessed 18/10/2024].

GOV.UK (2023b) Mental health services boosted by £150 million government funding. Available online [accessed 21/10/2024].

HMICFRS (2018) Policing and Mental Health: Picking up the pieces. Available online [accessed 18/10/2024].

HMICFRS (2024) Dip sampling. Available online [accessed 21/10/2024].

HO (2023) Policing Productivity Review. Available online [accessed 18/10/2024].

HO (2024a) Police powers and procedures: Stop and search, arrests and mental health detentions, England and Wales, year ending 31 March 2024 [accessed 21/10/2024]. To note, for the year ending March 2024 collection, guidance around the recording of “A&E” as a place of safety was changed. Therefore, the data for this year is not fully comparable to previous years.

HO (2024b) Police workforce England and Wales statistics. Available online [accessed 21/10/2024].

IOPC (2024) Right Care, Right Person position statement - March 2024. Available online [accessed 21/10/2024].

Jefferson L., Doran J., Gilburt H., Dale V., & Bloor K. (2024) Exploring Health and Social Care perspectives on the implementation of ‘Right Care, Right Person’, under the National Partnership Agreement. University of York, December 2024. Available online

NHSE (2023) NHS mental health dashboard. Available online [accessed 21/10/2024].

NHSE (2024a) NHS 111 offering crisis mental health support for the first time. [accessed 21/10/2024].

NHSE (2024b) Guidance on implementing the National Partnership Agreement: Right Care, Right Person. Available online [accessed 19/11/2024].

NPCC (2022) Mental Health & Policing Strategy 2022-2025. Available online [accessed 18/10/2024].

RCPsych (2022) Record 4.3 million referrals to specialist mental health services in 2021. Available online [accessed 22/10/2024].

Ritchie J, Spencer L. (1994) Qualitative data analysis for applied policy research. In: Bryman A, Burgess R, editors. In: Analyzing qualitative data: Qualitative data analysis for applied policy research; 10; Analyzing (taylorfrancis.com). London: Routledge..

Question 8

Annex A: HO semi-structured interviews topic guide

Accepted Answer

Right Care Right Person: Process evaluation research

Table A1: Interviewer’s discussion guide for RCRP semi structured interviews

Welcome and intro	Prompts	Moderator notes/comments	Time
Thank participant for taking part.		Orientate participant and get them prepared to take part in interview.	4 mins
Introduce self and role in Home Office.		Note taker and observer introductions. Recording of interview.
Outline the ‘rules’ of the interview (including those which we are required to tell them about under Data Protection Act guidelines).		Contained in the privacy notice: participation voluntary and can decline to answer any questions or stop the interview without giving explanation
Where possible to avoid sharing information that may lead to the identification of individuals.		Findings and anonymous quotes may be included in a final published report.
Briefly explain the background of the interview and research questions.		Understand best practice from forces and barriers to implementation, how force has implemented RCRP, what can be learnt from their experiences to take to other forces
We want the discussion to be informal in nature. Take participant through structure of the interview and how questions will flow so they know what to expect.		Topics are legal responsibilities, partnership working, impact of RCRP, training and data collection.
Inform participant of the outcome of the project		Discussion will take approximately 45 to 60 minutes.
Any questions?		Discussion will take approximately 45 to 60 minutes.
Consent to switch on recording, then switch on!		Report which will identify the main themes emerging from the discussions. Findings could also be included in a published and publicly available report. It will report on the findings of the interviews, but individuals will not be identified.
MODERATOR TO ASK THE FOLLOWING QUESTIONS IN TURN.		Clarify any questions and observer to switch on recording
Introduction	Prompts	Moderator notes/comments	Time
Ask participants to briefly introduce themselves, discuss their professional role and how long they have been working in the role.			1 min
Legal responsibilities	Prompts	Moderator notes/comments	Time
The first set of questions will be about your understanding of the force’s legal responsibilities under the RCRP approach.	Prompts below are to help the focus of the conversation, but they don’t need to be asked if it is covered in response to the original question.		10 mins
Thinking about any requests for assistance with mental health and other social care incidents that are related to the RCRP approach as implemented in your force.	If not mentioned, ask about their force’s responsibilities around Articles 2 and 3 of the Human Rights Act, the common law duty of care, and the force’s statutory duties.
Please could you explain your understanding of the force’s legal responsibilities around RCRP incidents.	Are there any challenges that you think may be easy or difficult to address?
What is your overall assessment of your force’s ability to meet your legal responsibilities for RCRP?	What do you think the main difficulties will be?
How will your force ensure compliance with your legal responsibilities?	What has worked well?
Please explain what, if any, policy changes your force has made to take into account the RCRP principles and your legal advice.	How do you feel this process of change has worked?
	Could you give any examples of what has worked well?
	And where you have encountered challenges?
Partnership working	Prompts	Moderator notes/comments	Time
The next set of questions will focus on partnership working, including health, social care, and other relevant partners.			10 mins
Please describe your force’s partnership working relationship with health and social care, prior to your work on RCRP.	Were there any changes in the relationships in planning stages for RCRP implementation? And since implementation?
Please explain what has worked well and if you have encountered any challenges.	Have there been any issues you can tell us about, or things that have worked well?
Please tell us about how you have engaged with third sector or voluntary agencies.	What has that been like? If any negative comments - how will you address or improve your relationships? For positive comments, how will you continue those working relationships?
And with any other partners or stakeholders?	Ask if they are aware of any engagement with PCCs and/or fire services. If so, what has that been like?
Just before, and since, implementation, tell us about any communication strategy you have had to engage stakeholders and partners.	Have there been any difficulties or issues raised?
And any comms strategy with the public.
Impact	Prompts	Moderator notes/comments	Time
The next section of questions we would like to ask is around your perceptions of the impact RCRP has had or will have for your force.			10 mins
You don’t need to provide us with exact numbers but please can you tell us generally what your perceptions are of the impact of the RCRP approach on: Deployment to MH and other RCRP incidents, attendance times and officer hours spent on RCRP incidents, any negative or adverse consequences arising from RCRP that you are aware of and any impact on partner agencies, for example, mental, or general health, or other social care.	Without identifying individuals, or agencies, could you give any examples?
Training	Prompts	Moderator notes/comments	Time
The next set of questions will focus on training in the RCRP approach for your staff.	How has it been implemented?		4 mins
Describe your force’s approach to training for RCRP.	Were there any challenges with training development or delivery?
	How are you ensuring consistency when responding to calls that require consideration of the RCRP approach?
Data collection	Prompts	Moderator notes/comments	Time
Tell us how your force has been collecting data to understand the demand around RCRP incidents.	Has the force made any changes to how it records RCRP incidents before and after implementation?		5 mins
What are your force’s plans for data collection and monitoring in relation to RCRP?	Has the data collected helped your understanding of RCRP demand?
Please tell us about any challenges or good practices your force has had in relation to data collection.	Do your IT systems have any impact on the data collection and monitoring capabilities?
Conclusion	Prompts	Moderators notes/comments	Time
Is there anything I have not yet covered that you would like to comment on?			1 min
Do you have any questions about what we have spoken about today?
Is there anything you would like to clarify about what you have told me?

Question 9

Annex B: HO police force visits observational topic guide

Accepted Answer

Observation log: Force Control Room (FCR)

Research issue: Right Care, Right Person (RCRP) implementation

Table A2: Observations log guide for RCRP force control room visits

Areas of observation	Observations	Questions
Knowledge of RCRP: What is the level of FCR staff awareness of the RCRP approach?	For example, are they aware of their responsibilities in dealing with mental health and social care issues, and aware of their legal responsibilities?	Generally, how would you say RCRP implementation has been received in the control room?
Training for RCRP: Has the staff member been trained in RCRP? Are they following the RCRP training to appropriately direct the call? Are they receiving support from managers to make decisions?	For example, are they following the National RCRP guidance and/or any decision-making model (NDM, THRIVE)?	For example, what training have you received about RCRP? How long was the training? Is there any more planned? Do you feel adequately trained for dealing with RCRP calls/incidents?
Implementation of RCRP: What are the issues / barriers encountered when handling calls relating to RCRP categories?	For example, were they able to identify the call as a RCRP category, was the threshold for police intervention identified and met?	From your experience, how are you finding RCRP implementation is working? Prompt: If participant describes a feeling, ask why or what’s contributing to that feeling.
Health & Social Care Partnership working: What engagement has there been with partners? (For example, health, mental health, local authority, fire, social services)	For example, was there a good level of engagement when working with partner agencies, any difficulties?	Overall, what is your experience of working with partner agencies? How would you describe any differences in your partnership relationships before the RCRP implementation and since it has been implemented?
Impact of RCRP: Was the call re-directed to a mental health or social care organisation? How much time spent was spent dealing with RCRP categories?	For example, was the unwarranted RCRP call allocated to the right partner appropriately, was the warranted call dealt with by the police?	Have you noticed any changes in how RCRP categories are dealt with since implementation?
Data collection: Was the data for the call/incident inputted accurately?	For example, were the number of patrols deployed recorded? Was the time taken to attend the incident and/or the handover time recorded?	Have there been any changes to how you record incidents relating to RCRP?

Question 10

Annex C: HO police force visits structured interview topic guide

Accepted Answer

Structured interviews

Research issue: Right Care, Right Person (RCRP) implementation

Table A3: Interviewer’s topic guide for RCRP structured interviews

Areas of observation	Observations	Questions
Knowledge of RCRP: What is the level of FCR staff awareness of the RCRP approach?	For example, are they aware of their responsibilities in dealing with mental health and social care issues, and aware of their legal responsibilities?	Generally, how would you say RCRP implementation has been received in the control room?
Training for RCRP: Has the staff member been trained in RCRP? Are they following the RCRP training to appropriately direct the call? Are they receiving support from managers to make decisions?	For example, are they following the National RCRP guidance and/or any decision-making model (NDM, THRIVE)?	For example, what training have you received about RCRP? How long was the training? Is there any more planned? Do you feel adequately trained for dealing with RCRP calls/incidents?
Implementation of RCRP: What are the issues / barriers encountered when handling calls relating to RCRP categories?	For example, were they able to identify the call as a RCRP category, was the threshold for police intervention identified and met?	From your experience, how are you finding RCRP implementation is working? Prompt: If participant describes a feeling, ask why or what’s contributing to that feeling.
Health & Social Care Partnership working: What engagement has there been with partners? (For example, health, mental health, local authority, fire, social services)	For example, was there a good level of engagement when working with partner agencies, any difficulties?	Overall, what is your experience of working with partner agencies? How would you describe any differences in your partnership relationships before the RCRP implementation and since it has been implemented?
Impact of RCRP: Was the call re-directed to a mental health or social care organisation? How much time spent was spent dealing with RCRP categories?	For example, was the unwarranted RCRP call allocated to the right partner appropriately, was the warranted call dealt with by the police?	Have you noticed any changes in how RCRP categories are dealt with since implementation?
Data collection: Was the data for the call/incident inputted accurately?	For example, were the number of patrols deployed recorded? Was the time taken to attend the incident and/or the handover time recorded?	Have there been any changes to how you record incidents relating to RCRP?

Question 11

Annex D: Police officer time saving calculation

Accepted Answer

Average incident time:

Incident time refers to the time it takes for officers to deal with an incident. This deal time can be calculated in a number of ways using different time-based variables, depending on what data forces have available. For this analysis, the time spent on incidents was considered to be the time from an officer being deployed to the time the incident was closed, including travel time.

This incident deal time was calculated for all concern for safety (CfS) incidents recorded in the year prior to implementation of RCRP. The data was used to calculate the median deal time for an incident across that year. The median was used to measure the average time for an incident deal time as it reduces the effects of outliers or skewed data.

Differences in number of incidents attended:

The number of CfS incidents each month were counted, pre and post implementation. These were used to calculate the difference in the number of CfS incidents deployed to year-on-year. To minimise seasonal effects, the data were compared for each month after implementation to the same month in the year prior to implementation.

Officer hours saved calculation:

For each month where both pre- and post-implementation data were available, the amount of officer time spent dealing with incidents was calculated as the difference in the number of incidents deployed to, multiplied by the average incident time (in seconds). This calculation provides an estimate of time spent on CfS incidents and may be less time if there was a reduction in incidents after implementation, or more time if there were more incidents.

Where data was available both pre- and post-implementation for several months, an average of time saved each month was calculated. The total time following implementation is divided by the number of months that data is available for post-implementation. This provides the average officer time per month over the comparison period.

These calculations provide a result in seconds, which are then converted into hours and minutes for ease of interpretation. In all cases there was a reduction in time spent; this is reported as officer time saved.

Officer hours saved with median officer deployed:

The calculation described so far assumed that only one officer was deployed to each incident. The deal time calculated considered the time from deployment to closure of an incident, without consideration to how many officers were deployed or in attendance and therefore is calculated for one officer’s time being spent at the incident. The assumption that only one officer would attend each CfS incident is likely an under-estimate of the time saved, as there are often multiple officers deployed.

The number of officers deployed to an incident is difficult to accurately determine as this data has several limitations. The number of officers is likely to vary across the time span that an incident is open, which is not necessarily captured in the data. For some forces, the data captured reflects the number of resources so may include non-police staff such as PCSOs and other forces record the number of ‘units’ which may be one or several officers.

However, the number of officers deployed data is captured by almost all of the forces in the sample, so these were used to calculate the median number of officers attending CfS incidents. The median was calculated for all incidents prior to implementation and then a separate median calculated for all incidents post-implementation. This was calculated to consider any differences that may have occurred following implementation. All forces that provided this data had a median of 2 officers deployed to incidents both prior to and post-implementation.

The median of 2 was incorporated into the calculation for each force by multiplying the officer time saved by 2 officers. This calculation assumes that time spent on incidents is doubled as 2 officers’ worth of time was spent on each incident.

Incident data recorded by the MPS captures the number of units deployed per incident. Using this data, it is not possible to determine the number of individual officers deployed. However, as analysis of other forces in our sample all showed a median of 2 officers attending incidents, a median of 2 officers was used in calculations for the MPS.

Time spent:

Each step of the calculation described was conducted for each force to provide an estimate of the total number of hours saved and the average hours saved each month following implementation of the CfS phase of RCRP.

It is important to note that this is an estimation with several assumptions being made around deal time, the number of incidents that may have taken place and the number of officers attending each incident. It is impossible to provide complete accuracy for how much time has been saved as we cannot know for certain how many incidents would have taken place, and how long incidents would have taken to deal with, had RCRP not been implemented. Data was compared pre and post-RCRP implementation to estimate the number of incidents and time spent dealing with them.

To put the officer hours saved calculations into context, the number of hours saved was converted to full time equivalent (FTE) officers. The NPCC Policing Productivity Review estimated an FTE officer hours to be 1,768 hours. The number of hours saved was divided by this to provide an estimate for how many FTE officers have been saved and freed up for other duties.

Proportion of officer hours saved:

Estimates were calculated for the officer hours saved following RCRP implementation as a proportion of the time spent CfS incidents for the same period in the year prior to implementation. This provided an opportunity to better contextualise the time savings and consider them proportionately, rather than in isolation.

Question 12

Annex E: Details of the HO online survey

Accepted Answer

RCRP Survey with policing staff

Methodology

An online survey was conducted with control room and operational staff from each police force. A survey was included in the HO process evaluation to obtain additional views from staff regarding implementation of the RCRP approach.

Questions for the survey included sections on working with partner agencies, training, the perceived impact of RCRP and data collection. These followed a similar format to the topic guides for the RCRP semi-structured interviews and observational visits. The survey contained closed questions for quantitative analysis, and open questions for qualitative analysis. Questions 22 to 28 were presented only to respondents who said they worked in contact or control rooms, questions 29 to 36 were presented only to respondents who said they worked in other policing roles, and all other questions were presented to all respondents.

The Smart Survey platform was used to deliver the survey to ensure HO data protection and security of data requirements were met. The survey was quality assured and tested to ensure the logic pathways worked correctly before it was published for use.

QR codes and links to the survey were provided for RCRP leads who distributed it to both force contact and control room staff and non-force contact and control room staff within their force. During the observational visits to police forces the survey was also promoted to staff through posters with links to the QR code. The survey was opened to respondents on the day of the force visit and remained available for completion for one week.

Cleaning data

Once the survey was closed each set of force data was downloaded from Smart Survey separately as an excel document. Data cleaning was conducted using the platform R, due to the comprehensive suite of tools it offers and ability to effectively manage large data sets. Excel files were uploaded to R to complete the cleaning and merging of data frames. Partial responses of individuals that did not complete the full survey were downloaded to a separate excel document. The data was then combined for each force. Data was checked to ensure responses had been recorded correctly, for example, ranks and roles were matched with selections made by police officer or police staff.

A clean data frame for all-respondent was created, respondent’s data was then removed if they:

did not consent to be in the survey
did not provide their force name
were not currently involved in work where RCRP is a factor
completed the survey after the deadline passed

Respondents were then spilt into 2 different data frames: ‘force contact and control room’ and all ‘other staff’. This was done for the 3 forces separately, then individual force data frames were bound together and exported to excel files for analysis.

Responses

In total, 221 responses were received, of which 127 provided sufficient information for analysis. Of the 127 responses, 72 respondents were from enquiry office and force contact or control rooms (contact and control room staff) and 55 were from other staff including custody, investigation, MASH, neighbourhood and response, project support, and street triage.

Data analysis and coding

Analyses of responses were calculated for ‘all respondents’ (127), along with responses for ‘control room and contact staff’ (72) and ‘other staff’ (55). Not all questions were answered by each respondent. The percentage for each response option was determined from the number of responses to each question.

The survey open questions were coded by researchers using template analysis, following the same template used for the semi-structured interviews and observations (see main report for details).

Findings

The themes and topics identified in the process evaluation are shown in table 2 below.

Table A4: Themes and topics identified in the process evaluation

Theme	Topic	Topic	Topic	Topic
Knowledge of RCRP and police legal responsibilities	Knowledge	Police duty of care and safeguarding	Police powers and response	Decision making
Partnership working	Partners’ knowledge and legal responsibilities	Engagement with partners	Application of the RCRP approach with partners	Impact of RCRP when working with partners
Application of the RCRP approach	For the public	Practices and processes of the RCRP approach
Impact of RCRP	Police RCRP decision making	Operational outcomes for the police	Outcomes for the public
Training	Practices and processes	Support for staff
Data collection	Practices and processes	Handover times	Incident data recording

Where survey questions related to the themes identified in the findings, results were added to the process evaluation report. The findings included in this report contain analysis of the survey questions (number of respondents, responses to each option and percentages), and key quotes from the coded open text boxes.

Knowledge of RCRP and police legal responsibilities

Decision making

Question 12. Are you aware of the police’s legal basis for making decisions relating to the Right Care, Right Person approach?

Table A5: Responses and percentages for question 12, including all respondents, control room and contact staff, and other staff

Respondent	Number in sample	Number of responses	Response options number and (%)
			Yes	No	Not sure
All respondents	127	123	101(82%)	11(9%)	11(9%)
Control/contact staff	72	72	65(90%)	3(4%)	4(6%)
Other staff	55	51	36(71%)	8(16%)	7(14%)

Impact of RCRP

Police RCRP decision making

Question 20. How confident are you to make decisions that are in line with Right Care, Right Person principles?

Table A6. Responses and percentages for question 20, including all respondents, control room and contact staff, and other staff

Respondent	Number in sample	Number of responses	Response options number and (%)
			Very confident	Somewhat confident	Neutral	Not very confident	Not confident at all
All respondents	127	92	21(23%)	46(50%)	14(15%)	10(11%)	1(1%)
Control/contact staff	72	71	16(23%)	36(51%)	11(15%)	8(11%)	0(0%)
Other staff	55	21	5(24%)	10(48%)	3(14%)	2(10%)	1(5%)

Question 24. What impact, if any, has Right Care, Right Person had on your decision making when considering the deployment of patrols to an incident?

Table A7: Responses and percentages for question 24 for control room and contact staff

Respondent	Number in sample	Number of responses	Response options number and (%)
			High impact	Medium impact	Low impact	No impact	Not sure
All respondents	127	N/A
Control/contact staff	72	68	29(43%)	32(47%)	6(9%)	0(0%)	1(1%)
Other staff	55	N/A

Operational outcomes for the police

Question 26. Since the Right Care, Right Person approach was introduced, what has the impact been on the deployment of police resources to incidents that relate to Right Care, Right Person?

Table A8: Responses and percentages for question 26 for control room and contact staff

Respondent	Number in sample	Number of responses	Response options number and (%)
			Decreased a lot	Decreased a little	No difference	Increased a little	Increased a lot	Not sure
All respondents	127	N/A
Control/contact staff	72	68	21(31%)	37(54%)	1(1%)	1(1%)	0(0%)	8(12%)
Other staff	55	N/A

Question 33. Overall, how much impact do you feel the implementation of Right Care, Right Person has affected your deployment to incidents that relate to Right Care, Right Person?

Table A9: Responses and percentages for question 33 for other staff

Respondent	Number in sample	Number of responses	Response options number and (%)
			High impact	Medium impact	Low impact	No impact	Not sure
All respondents	127	N/A
Control/contact staff	72	N/A
Other staff	55	50	7(14%)	23(46%)	9(18%)	8(16%)	3(6%)

Question 37. To what extent has Right Care, Right Person had a positive or negative impact on your day-to-day workload?

Table A10: Responses and percentages for question 37, including all respondents, control room and contact staff, and other staff

Respondent	Number in sample	Number of responses	Response options number and (%)
			Very positive	Positive	Neutral	Negative	Very negative	Not sure
All respondents	127	120	11(9%)	49(41%)	47(39%)	6(5%)	2(2%)	5(4%)
Control/contact staff	72	70	5(7%)	30(43%)	30(43%)	3(4%)	0(0%)	2(3%)
Other staff	55	50	6(12%)	19(38%)	17(34%)	3(6%)	2(4%)	3(6%)

Outcomes for the public

Question 27. Since the Right Care, Right Person approach was introduced, what has the impact been on call volumes from the public that relate to Right Care, Right Person?

Table A11: Responses and percentages for question 27 for control room and contact staff

Respondent	Number in sample	Number of responses	Response options number and (%)
			Decreased a lot	Decreased a little	No difference	Increased a little	Increased a lot	Not sure
All respondents	127	N/A
Control/contact staff	72	68	1(1%)	10(15%)	36(53%)	1(1%)	0(0%)	20(29%)
Other staff	55	N/A

Training

Practices and processes

Q13. Have you received training on the Right Care Right Person approach?

Table A12: Responses and percentages for question 13 including all respondents, control room and contact staff, and other staff

Respondent	Number in sample	Number of responses	Response options number and (%)
			Yes	No	Not sure
All respondents	127	123	92(75%)	27(22%)	4(3%)
Control/contact staff	72	72	71(99%)	1(1%)	0(0%)
Other staff	55	51	21(41%)	26(51%)	4(8%)

Q19. Overall, how satisfied, or dissatisfied are you with the Right Care, Right Person training that has been provided?

Table A13: Responses and percentages for question 19 including all respondents, control room and contact staff, and other staff

Respondent	Number in sample	Number of responses	Response options number and (%)
			Very satisfied	Satisfied	Neither satisfied nor dissatisfied	Dissatisfied	Very dissatisfied	Not sure
All respondents	127	92	15(16%)	44(48%)	23(25%)	8(9%)	1(1%)	1(1%)
Control/contact staff	72	71	12(17%)	36(51%)	15(21%)	7(10%)	0(0%)	1(1%)
Other staff	55	21	3(14%)	8(38%)	8(38%)	1(5%)	1(5%)	0(0%)

Data collection

Handover times

Q34. Since the implementation of Right Care, Right Person, have you noticed any change in the length of wait times/ handover times to partners?

Table A14: Responses and percentages for question 34 for other staff

Respondent	Number in sample	Number of responses	Response options number and (%)
			Wait times/handover times have increased a lot	Wait times/handover times have increased a little	No difference	Wait times/handover times have decreased a little	Wait handover times have decreased a lot	Not sure
All respondents	127	N/A
Control/contact staff	72	N/A
Other staff	55	50	6(12%)	2(4%)	27(54%)	6(12%)	0(0%)	9(18%)

Question 13

Annex F: Full findings from the third DHSC RCRP implementation survey

Accepted Answer

Local partnerships

Question: Does your local partnership include:

Question options	ICB(n=34)	LA(n=36)
Local police force(s)	32(94%)	32(89%)
Local authority (including adult and children social care and housing services)	32(94%)	N/A
Wider services for children and young people including education	16(47%)	16(44%)
Safeguarding boards and partnerships	19(56%)	21(58%)
Voluntary, community, and social enterprise sector	21(62%)	17(47%)
Local fire service	23(68%)	17(47%)
People with lived experience, their families, and carers	15(44%)	8(22%)
Mental Health Trusts	33(97%)	30(82%)
Acute Trusts	33(97%)	26(72%)
NHSE-led MHLDA provider collaboratives	14(41%)	10(28%)
Ambulance trusts	31(94%)	27(75%)
We have no local partnership working on RCRP at the moment	1(3%)	2(6%)

Progress on implementation

The number of responses to each phase indicates the number of ICBs/LAs which have either implemented or established a date for implementation of this phase. Where an area was working with multiple police forces, the earliest date was selected.

ICB survey:

Of 26 responding ICBs,
21 (81%) implemented Concern for welfare related to a person’s mental health needs before 28th March 2024 and 5 (19%) had agreed a future date to implement.
Of 24 responding ICBs,
21 (88%) implemented Other concerns for welfare (For example, not related to a person’s mental health needs) before 28th March 2024 and 3 (12%) had agreed a future date to implement.
Of 21 responding ICBs,
15 (71%) implemented People who leave acute hospitals, including ED before treatment is complete before 28th March 2024 and 6 (29%) had agreed a future date to implement.
Of 22 responding ICBs,
17 (77%) implemented People who absent themselves from inpatient mental health services or do not return from leave when expected before 28th March 2024 and 5 (23%) had agreed a future date to implement.
Of 18 responding ICBs,
10 (56%) implemented Transportation of patients before 28th March 2024 and 8 (44%) had agreed a future date to implement.
Of 19 responding ICBs,
11 (58%) implemented Reducing s136 handover times between police and health and care partners before 28th March 2024 and 8 (42%) had agreed a future date to implement.

LA survey:

Of 23 responding LAs,
14 (61%) implemented Concern for welfare related to a person’s mental health needs before 28th March 2024 and 9 (39%) had agreed a future date to implement.
Of 19 responding LAs,
12 (63%) implemented Other concerns for welfare (For example, not related to a person’s mental health needs) before 28th March 2024 and 7 (37%) had agreed a future date to implement.
Of 20 responding LAs,
10 (50%) implemented People who leave acute hospitals, including ED before treatment is complete before 28th March 2024 and 10 (50%) had agreed a future date to implement.
Of 21 responding LAs,
10 (48%) implemented People who absent themselves from inpatient mental health services or do not return from leave when expected before 28th March 2024 and 11 (52%) had agreed a future date to implement.
Of 12 responding LAs,
7 (58%) implemented Transportation of patients before 28th March 2024 and 5 (42%) had agreed a future date to implement.
Of 12 responding LAs,
7 (58%) implemented Reducing s136 handover times between police and health and care partners before 28th March 2024 and 5 (42%) had agreed a future date to implement.

Application to children and young people

Question: Is your local police force applying RCRP to children and young people (mental and/or physical health incidents)? Areas working with more than one police force could select multiple options.

Response option	ICB(n=35)	LA(n=36)
Mental health needs	22(63%)	13(36%)
Physical needs	10(29%)	8(22%)
Other needs	7(20%)	6(17%)
No	5(14%)	5(14%)
Not currently doing so	5(14%)	6(17%)
Don’t know	5(14%)	10(28%)

Health-based places of safety:

Question: Do you feel your HBPoS can sufficiently meet the demand at the moment? This question was only included in the ICB survey.

Response options	ICB(n=35)
Yes	14(40%)
No	21(60%)

Question: Why do you feel your HBPoS cannot sufficiently meet the demand at the moment? ICBs could select multiple options. This question was only included in the ICB survey.

Response options	ICB(n=21)
Availability of inpatient beds - adult acute	18(86%)
Volume of S136 detentions locally	14(67%)
Availability of inpatient beds - children and young people	11(52%)
Reduced capacity in suites due to supporting children or young people	11(52%)
Damage to suites and time for repairs	10(48%)
Availability of S12 doctors	9(43%)
Availability of AMHPs	5(24%)
Police using suites in neighbouring areas without prior agreement	5(24%)

Barriers:

Questions: Have you experienced any barriers to implementation in your local area?

Respondent	Number in sample	Number of responses	Response options number and (%)
			High impact	Medium impact	Low impact	No impact	Not sure
All respondents	127	N/A
Control/contact staff	72	68	29(43%)	32(47%)	6(9%)	0(0%)	1(1%)
Other staff	55	N/A

Question: Please tick all the barriers you have faced/currently face during implementation in your local area. ICBs and LAs could select more than one option.

Response options	ICBs(n=21)	LAs(n=14)
Cost/funding pressure	18(86%)	7(50%)
Lack of clarity regarding responsibilities of agencies when responding to incidents	15(71%)	9(64%)
Lack of workforce to cope with demands	14(67%)	9(64%)
Time pressure to implement	12(57%)	9(64%)
Lack of infrastructure to accommodate RCRP (including facilities like HBPoS)	12(57%)	10(71%)
A gap in service provision in the area	9(43%)	6(43%)
Lack of support at national level (for example guidance, legal questions)	9(43%)	6(43%)
Multi-agency collaboration at local level towards implementation not working well	3(14%)	4(29%)
Other	6(29%)	2(14%)

Question: Which barrier is obstructing RCRP rollout the most in your local area? ICBs and Local authorities could only select one option.

Response options	ICBs(n=21)	LAs(n=12)
Cost/funding pressure	6(29%)	3(25%)
Lack of clarity regarding responsibilities of agencies when responding to incidents	2(10%)	3(25%)
Lack of workforce to cope with demands	2(10%)	0(0%)
Time pressure to implement	4(19%)	0(0%)
Lack of infrastructure to accommodate RCRP (including facilities like HBPoS)	1(5%)	3(25%)
A gap in service provision in the area	0(0%)	0(0%)
Lack of support at national level (for example guidance, legal questions)	1(5%)	1(8%)
Multi-agency collaboration at local level towards implementation not working well	0(0%)	2(17%)
Other	5(24%)	N/A

Demand

Question: Do you think RCRP will increase demand on these services in your area?

ICB survey:

Service type	Significantly more demand	Moderately more demand	No impact	Moderately less demand	Much less demand
Ambulance services	13(37%)	19(54%)	2(6%)	1(3%)	0(0%)
Community Mental Health teams	5(14%)	25(71%)	5(14%)	0(0%)	0(0%)
Mental Health Crisis teams(n=34)	15(44%)	19(56%)	0(0%)	0(0%)	0(0%)
Crisis alternatives(such as crisis cafes, crisis houses)	10(29%)	20(57%)	5(14%)	0(0%)	0(0%)
Mental Health inpatient services	5(14%)	15(46%)	13(37%)	1(3%)	0(0%)
Voluntary, community and social enterprise	6(17%)	23(66%)	6(17%)	0(0%)	0(0%)
Urgent and emergency care	9(26%)	22(63%)	3(9%)	1(3%)	0(0%)
Mental Health crisis lines/NHS 111 (Select MH option).	15(43%)	16(46%)	4(11%)	0(0%)	0(0%)

Of 35 responding ICBs: (If the response number from ICBs differed from 35 for a specific service type then it is indicated next to the service type name)

LA survey:

The number of responding LAs for each service type is indicated alongside the name of the service type.

Service type	Significantly more demand	Moderately more demand	No impact	Moderately less demand	Much less demand
Ambulance services(n=35)	11(31%)	20(57%)	4(11%)	0(0%)	0(0%)
Community Mental Health teams(n=35)	7(20%)	21(60%)	6(17%)	1(3%)	0(0%)
Mental Health Crisis teams(n=34)	9(26%)	20(59%)	5(15%)	0(0%)	0(0%)
Crisis alternatives (such as crisis cafes, crisis houses)(n=33)	8(24%)	17(52%)	7(21%)	0(0%)	1(3%)
Mental Health inpatient services (n=34)	4(12%)	19(56%)	11(32%)	0(0%)	0(0%)
AMHPs(n=35)	6(17%)	21(60%)	8(23%)	0(0%)	0(0%)
Other adult and social care services(n=35)	6(17%)	20(57%)	8(23%)	1(3%)	0(0%)
Voluntary, community and social enterprise(n=33)	4(12%)	16(48%)	12(36%)	1(3%)	0(0%)
Urgent and emergency care(n=34)	12(35%)	17(50%)	5(15%)	0(0%)	0(0%)
Mental Health crisis lines/NHS 111 (Select MH option).(n=33)	11(33%)	18(55%)	4(12%)	0(0%)	0(0%)

Safety incidents

Question: Have any incidents occurred that are believed to be related to RCRP that affected or had the potential to affect the safety or wellbeing of patients, staff members or other members of the public?

Response options	ICBs(n=35)	LAs(n=35)
Yes	19(54%)	13(37%)
No	8(23%)	13(37%)
Don’t know	8(23%)	9(26%)

Question: Have you got an escalation protocol in place that is agreed with the police and other multiagency partners involved in implementation? ICBs and LAs could select more than one option.

Response options	ICBs(n=35)	LAs(n=34)
Multi-agency real-time escalation protocol in place	19(54%)	18(53%)
Retrospective escalation protocol in place	16(46%)	7(21%)
An agreed protocol was currently in development	15(43%)	10(29%)
No protocol in place	1(3%)	4(12%)

Question: Have you agreed a strategy to learn from adverse incidents (for example, incidents in which someone’s safety was at risk or service delivery was interrupted) should they occur? This question was only included in the LA survey.

Response options	LAs(n=35)
Yes	8(23%)
Yes, including how to share this learning more widely	2(6%)
Currently in development	11(31%)
No	7(20%)
Don’t know	7(20%)

Topic	Question	Response
Knowledge of RCRP	What does Right Care Right Person (RCRP) mean for you in relation to your role? What do you think is the main aim of the RCRP approach? Please explain your response. Briefly describe your understanding of your legal responsibilities related to the RCRP approach? In your experience, how would you say implementation of the RCRP approach has been received by frontline officers?
Training for RCRP	What, if any, training have you received relating to RCRP? How long was the RCRP training? Is there any more training planned for you? If you haven’t received training, what information have you received regarding the RCRP approach? Do you feel adequately trained or informed for dealing with RCRP calls/incidents? Do you feel you receive support from your managers to make decisions around mental health and social care issues you deal with?
Implementation of RCRP	Briefly describe any issues or barriers you have encountered when handling calls/incidents relating to RCRP categories. From your experience, how do you feel the RCRP approach is working? Why or what is contributing to that feeling?
Health & Social Care Partnership working	What, if any, engagement do you generally have with partners? (For example, health, mental health, local authority, fire, social services). Overall, what is your experience of working with partner agencies? What, if any, differences have you found in your partnership relationships before the RCRP implementation, and since it has been implemented?
Impact of RCRP	How much time do you generally spend dealing with RCRP categories of incidents? What experience have you had of incidents that you feel could or should be re-directed to a mental health or social care organisation? What, if any, impact do you feel RCRP has had on your day-to-day role? Have you noticed any changes in how RCRP categories are dealt with since its implementation?
Data collection	Do you think the time taken to attend an RCRP incident and/or the handover time for incidents is recorded accurately? Please explain your response. Have there been any changes to how you record data relating to RCRP calls or incidents?

Cookies on GOV.UK

Applies to England and Wales

Glossary of terms

Acknowledgements

Executive summary

Introduction

Key findings

Good practices in implementation

Partnership working

Barriers to implementation

Unintended consequences, risks, and learning

Early perceived impacts of RCRP

Police data monitoring

Conclusions

1. Introduction

1.1 Background

1.1.1 Policing and mental health

1.1.2 Police demand and mental health incidents

1.1.3 Health and social care services and mental health demand

1.1.4 Right Care, Right Person approach

1.1.5 National Partnership Agreement (NPA)

1.2 Supporting activities

1.2.1 Guidance

1.2.2 NPCC national implementation team

1.3 Research activities

1.3.1 Aims

1.3.2 HO research activities

1.3.3 DHSC research activities

2. Methodology

2.1 Outline of research sample

2.2 Process evaluation

2.2.1 HO methodology

2.2.2 DHSC methodology

2.3 Police data monitoring

3. Findings

3.1 Police

3.1.1 HO process evaluation findings

3.1.2 Knowledge of RCRP and police legal responsibilities

3.1.3 Partnership working

3.1.4 Application of the RCRP approach

3.1.5 Impact of RCRP

3.1.6 Training

3.1.7 Data collection

3.1.8 Early quantitative findings

3.1.9 Essex Police

Figure 1: Essex Police concern for safety (CfS) incidents and deployments between September 2022 and January 2024

3.1.10 Metropolitan Police Service (MPS)

Figure 2: Metropolitan Police Service concern for safety (CfS) incidents and deployments between November 2022 and January 2024

Figure 3: Metropolitan Police Service mental health (MH) incidents and deployments between November 2022 and January 2024

Figure 4: Metropolitan Police Service RCRP incidents and deployments between November 2022 and January 2024

3.1.11 Northamptonshire Police

Figure 5: Northamptonshire Police concern for safety (CfS) incidents and deployments between July 2022 and January 2024

Figure 6: Northamptonshire Police mental health (MH) incidents and deployments between July 2022 and January 2024

3.1.12 South Yorkshire Police (SYP)

Figure 7: South Yorkshire Police concern for safety (CfS) incidents and deployments between March 2022 and January 2024

Figure 8: South Yorkshire Police mental health (MH) incidents and deployments between March 2022 and January 2024

3.1.13 Thames Valley Police

Figure 9: Thames Valley Police concern for safety (CfS) incidents and deployments between May 2022 and January 2024

Figure 10: Thames Valley Police mental health (MH) incidents and deployments between May 2022 and January 2024

3.1.14 Key insights

Table 1: Estimated officer hours saved across forces per month

3.2 Health and social care

3.2.1 Implementation findings

3.2.2 Implementation process

3.2.3 Partnership working

3.2.4 Critical success factors

3.2.5 Risks

3.2.6 Local risk management

3.2.7 Perceived impacts

3.3 Fire

3.3.1 Findings

3.3.2 Knowledge of RCRP

3.3.3 Legal responsibilities of police and fire services

3.3.4 Application of RCRP

3.3.5 Engagement with partners

3.3.6 Training for RCRP

3.3.7 Impact of RCRP

4. Discussion

4.1 Good practices in implementation

4.1.1 Communication and engagement