Managing risk in the community – learning from the implementation of the National Partnership Agreement

In July 2023, the Home Office, Department of Health and Social Care, National Police Chiefs’ Council, Association of Police and Crime Commissioners and NHS England announced an agreement to work to end inappropriate and avoidable involvement of police in responding to incidents involving people with mental health needs.

The National Partnership Agreement (NPA) covers implementation of a strategic approach across England known as Right Care, Right Person developed by Humberside Police. Unlike NHS organisations, each local police force is operationally independent; therefore, implementation is subject to local agreements between police forces, health bodies and local authorities identifying how to implement the approach that best meets the needs of the local population in a timeframe appropriate for that process. In practice, this has led to agreements being implemented before the development of guidance for the health and care sector, and all partners are learning as they go.

To support that learning, the Department of Health and Social Care commissioned the University of York and The King’s Fund to capture early learning from implementation between September 2023 and February 2024. Together, we spoke to managers and health care professionals from mental health trusts, acute hospitals, A&E, social care, and voluntary, community and social enterprise (VCSE) sector organisations to understand their experiences of Right Care, Right Person and its perceived impact on access to care.

Despite initial controversy, there was general agreement among interviewees that wherever possible people in need of mental health support should receive that from health services, and that the balance of police involvement had shifted too far, with health and care organisations using the police by default rather than as required. Redressing that balance has led to a change in policies and practice, outlining additional activities staff need to undertake to respond to the needs of patients and establishing a ‘threshold’ for escalation of issues to the police. In some areas, implementation of NPA had also supported better relationships at a strategic level between agencies.

This shift away from reliance on the police, however, has come at a point at which health and care services are experiencing record demand and workforce pressures. Even with agreements in place, staff do not always have the resources and capacity to fulfil that role. In addition, expectations of organisations to respond do not always meet their capabilities to do so. For instance, in some areas, ambulance services have been tasked with responding to concerns for welfare, but their inherent categorisation and prioritisation of need means that these calls unfortunately come far down the list of priorities. Similarly, leaders of VCSE sector organisations told us that although they may have concerns for someone’s welfare, they were often not commissioned or equipped to assess an individual’s needs, leaving a gap in response.

This gap in response is concerning. One of the consequences of the police’s decision to withdraw their universal response to calls is that it is highlighting needs that fall outside the remit and thresholds for the intervention of existing health and care organisations. As one trust leader told us:

For staff, the changes have led to uncertainty about what provisions are in place and the confidence that other agencies will respond accordingly. Some staff told us this undermined their perceived duty of care to patients. Other staff describe the withdrawal of a police response and their associated powers as potentially putting them and others at greater risk, a concern echoed by the Royal College of Emergency Medicine.

In theory, the changes under Right Care, Right Person should ensure that the police continue to respond to emergency situations when required. However, the lack of a common understanding around key issues, such as what constitutes mental illness and perceptions of risk, mean that the threshold for response often remains unclear. In addition, interviewees told us about local variations in response and the police no longer responding to issues outside of the NPA (such as incidents of violence on health care premises), as well as receiving blanket responses of, ‘We don’t do mental health’.

While it is still early days, indications are that the consequences for people with mental illness should be a key concern. During our research, interviewees brought to light several examples that indicated potential harm to individuals and the public, while incidents in other areas of the country have led to a pause in implementation of the policy.

The aims of the National Partnership Agreement reflect a longstanding concern about the encroaching role of the police in mental health and the impact this has both on people with mental illness and on the wider community in their reduced capacity to tackle crime. At its best, the National Partnership Agreement challenges staff and services to think about the response that best meets the needs of people with mental illness. But the speed of implementation, coupled with the complexity and fragmentation of mental health care, means that at its worst, people risk being left without any response at their point of greatest need.