Report on an inspection visit to police custody suites in Gwent Police

Summary

This report describes our findings following an inspection of Gwent Police custody facilities. The inspection was conducted jointly by HM Inspectorate of Constabulary and Fire & Rescue Services (HMICFRS) and Health Inspectorate Wales (HIW) in August and September 2024. It is part of our programme of inspections covering every police custody suite in England and Wales.

The inspection assessed the effectiveness of custody services and outcomes for detained people throughout the different stages of detention. It examined the force’s approach to custody provision in relation to detaining people safely and respectfully, with a particular focus on children and vulnerable adults.

To help the force improve, we have made two recommendations to it and its police and crime commissioner. These address our main causes of concern.

We have also highlighted a further 12 areas for improvement. These are set out in section 6 of this report.

Leadership, accountability and working with partners

Gwent Police has a clear governance structure for providing safe and respectful custody services. But there are limited strategic and operational governance arrangements to oversee custody. A strategic force performance board meeting, chaired by an assistant chief constable, provides some governance and oversight of custody data, but this data is high level – for example, total throughput, total refused detentions, total strip searches and some disproportionality data. There are no other formal police leadership meetings at the force level or the custody management level to scrutinise custody services and their quality.

The limited governance and oversight of custody means there are some critical weaknesses in how the force provides custody services. Some of the recommendations from our last inspection, which was in 2017, haven’t been achieved or have only partly been achieved, leaving some key areas of custody needing urgent attention. These include governance, managing and overseeing custody services, and overseeing the use of force, risk management and mental health. Together, these areas are a cause of concern.

There is no performance framework or regular performance scrutiny to assess how well the force provides custody services. This means it can’t identify any underperformance and therefore can’t put in place measures to make improvements over time. The force could provide some of the information we asked for, but some important information was missing – for example, the time children and vulnerable adults wait for support from an appropriate adult (AA), waiting times for mental health assessments, and how long those in mental health crisis remain in custody. Members of the workforce don’t routinely monitor this information, and often they don’t record it clearly on custody records, so the force can’t determine how well it is meeting detainees’ needs. Some information is inaccurate, especially about the use of force in custody.

There is minimal recording on custody records to show when force was used, who used it and why it was necessary. Not all officers are completing use of force forms, as is required by guidance from the National Police Chiefs’ Council (NPCC). There is little quality assurance of incidents or monitoring of the use of force at a strategic or operational level, and no custody-specific external scrutiny, using CCTV reviews, of the use of force. The limited scrutiny that does take place is hindered by inaccurate information and poor CCTV coverage. This means the force can’t show that when it uses force or restraint in custody, it is necessary, justified and proportionate.

There is no formal quality assurance process. Custody inspectors try to dip sample ten records each month, but they don’t record the findings from the dip samples. This means they can’t identify themes or use the review process to improve performance.

The force has adopted the College of Policing’s authorised professional practice (APP), but members of the workforce don’t always follow it. This contributes to the inconsistent practices we saw in our inspection, such as:

• removing cords and laces from detainees without carrying out individualised risk assessments;
• setting inappropriate observation levels to intoxicated detainees; and
• not completing logs during level 3 and 4 observations and handover procedures.

The force understands the public sector equality duty. It monitors data on detainee throughput, total numbers of strip searches, refused bail and detention lengths to identify any potential disproportionality by age, gender and ethnicity. The members of the quarterly external scrutiny panel, which includes members of the independent advisory group, discuss this data. This is positive.

There is a clear priority to divert children away from custody. Joint work with the youth offending teams, Welsh Government and the Probation Service is aimed at making sure children are kept safe from harm, aren’t kept in custody for longer than necessary, and re-offending is prevented or minimised. Children are discussed at meetings such as the Gwent monitoring review panel, the child-centred strategic steering group and the local safeguarding board. But local authorities can rarely provide other accommodation for children who are charged and remanded, so they aren’t moved from custody as they should be.

It is unclear what work the force has done with mental health services to help people with mental health conditions. Outcomes for people detained under section 136 of the Mental Health Act 1983 outside custody, and for those needing assessments in custody, are still poor.

Newport custody suite is well maintained, but there were some potential ligature points around cell door frames. We found similar potential ligature points at Ystrad Mynach. We gave the force an illustrative report citing all potential ligature points, as well as feedback on its general conditions, and it began to consider how it could make changes.

Pre-custody – first point of contact

Frontline officers have a good understanding of what makes a person vulnerable, and they take account of this when deciding whether to make an arrest or deal with the incident in another way.

Frontline officers try to divert children away from custody when possible, and they only arrest children when no alternatives are available. They consider:

• arranging to interview the child later outside custody;
• using community resolutions; and
• referring the child to the youth offending team, which can offer support and intervention activities.

Officers told us they feel well supported when dealing with people with mental health conditions. They receive support from a mental health triage service in the control room. They value this service and said it helps them avoid some section 136 detentions because alternative health arrangements are sometimes made instead. But officers told us that when a detainee needs a mental health assessment, there is regularly a long wait. This is poor use of police time.

In the custody suite – booking-in, individual needs and legal rights

Custody personnel are respectful, and they show empathy and understanding in their interactions with detainees. All detainees we observed during booking-in were offered the chance to speak to someone in private about their health and well-being, or to disclose confidential information.

The design of the suite in Newport means there is limited privacy at the booking-in area, and the environment can be noisy when more than one detainee is booked in at the same time.

The custody suite in Newport has some facilities to meet the needs of detainees with disabilities that affect their mobility, hearing or sight.

The force meets the needs of women detainees as best it can.

Detainees can observe their faith while in custody, and there is an extensive range of religious items relating to the major religions.

The force generally identifies detainee risk well, but it doesn’t always follow APP guidance for risk management. Risk management forms part of our cause of concern.

Custody officers generally book detainees in promptly. But during busy periods, detainees can spend a long time waiting in holding areas or police vehicles. This is contrary to APP guidance.

Some custody officers routinely decide to remove detainees’ footwear. They don’t always cite the reasons for this on the custody record, which is contrary to the Police and Criminal Evidence Act 1984 (PACE), code C 2023, paragraph 4.5. We saw custody officers carrying out risk assessments to check for cords or other items of clothing that could be used as ligatures. But we also saw some custody officers removing belts and cords as a matter of course, so there doesn’t seem to be a consistent approach.

Inspectors don’t always carry out reviews of detention for detainees well enough. In our custody record analysis and case audits, we saw some good examples of PACE reviews, completed with reference to the detainee’s specific circumstances. But we also saw some poor reviews. Some were completed early or late, and sometimes inspectors hadn’t spoken to the detainee as they had considered the detainee to be unfit.

In the custody cell – safeguarding and healthcare

The force’s approach to detainee care is good. Custody personnel are considerate and do their best to meet detainees’ care needs. The detainees we spoke to were positive about the care they received while in custody.

The force doesn’t have a specific safeguarding policy. Custody personnel notify social services when a child is brought into custody, so they can exchange risk information when necessary. During our inspection, we saw good examples of custody officers considering the safeguarding needs of children and vulnerable adults, and making referrals for when they leave custody. All children in custody are referred to the healthcare professional (HCP) for a juvenile assessment.

The force doesn’t monitor how long it takes for an AA to arrive, so it can’t assure itself that support is always given at the earliest time, or that the arrangements for providing AAs are effective. This hasn’t improved since our last inspection.

The force has a clear approach to diverting children away from custody when possible. It uses voluntary attendance and early social services intervention as an alternative to custody. There is some scrutiny of the experiences of children in custody. But the force could do more to further scrutinise outcomes for children in custody, such as by carrying out more robust dip-sampling of children’s records. This should include examining how long it takes for AAs to attend and whether girls have been assigned a female carer.

Healthcare is provided directly by Gwent Police, which employs a range of HCPs to fulfil this service.

There is a good working relationship between the force’s mental health lead and partners such as health and social care services. There is a focus on working together to resolve and manage any difficulties. But the force doesn’t monitor the waiting times for any detainees who are referred for an assessment under the Mental Health Act 1983 and need to be transferred from custody to a mental health hospital. This means it doesn’t know how effective its arrangements with partner organisations are.

Release and transfer from custody

There is a clear focus on releasing detainees safely. But custody officers don’t oversee the completion of digital person escort record forms well enough.

Arrangements for detainees to attend court generally work well.

When detainees are remanded, they are usually transferred, in person, to the next available court. The force’s contractor attends the custody suite each morning to escort detainees to court. It provides separate transport for child detainees.

Causes of concern and recommendations

Introduction

This report is one in a series of inspections of police custody carried out jointly by HMICFRS and HIW. These inspections are part of the joint work programme of the criminal justice inspectorates and contribute to the UK’s response to its international obligations under the United Nations Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT).

The national rolling programme of police custody inspections, which began in 2008, makes sure that custody facilities in all 43 forces in England and Wales are inspected regularly.

OPCAT requires that all places of detention are visited regularly by independent bodies – known as the National Preventive Mechanism (NPM) – which monitor the treatment of, and conditions for, detainees. HMICFRS and HIW are two of several bodies making up the NPM in the UK.

Our inspections assess how well each police force fulfils its responsibilities when detaining people in police custody, and the outcomes for them. This includes how safely they are managed and how respectfully they are treated.

Our assessments are made against the criteria set out in our ‘Expectations for police custody’. These standards are underpinned by international human rights standards and are developed by the two inspectorates. We consult other expert bodies on them across the sector and they are regularly reviewed. This helps to achieve best custodial practice and promote improvements.

The expectations are grouped under five inspection areas:

• leadership, accountability and working with partners;
• pre-custody – first point of contact;
• in the custody suite – booking-in, individual needs and legal rights;
• in the custody cell – safeguarding and healthcare; and
• release and transfer from custody.

The inspections also assess compliance with PACE 1984, its codes of practice and the College of Policing’s authorised professional practice – detention and custody.

The methodology for carrying out the inspections is based on:

• a review of a force’s strategies, policies and procedures;
• an analysis of force data;
• interviews and focus groups with personnel;
• observations in suites, including discussions with detainees; and
• an examination of case records.

We also analyse a representative sample of custody records from all suites in the force area for the week before the inspection starts. For Gwent Police, we analysed a sample of 97 records. The methodology for our inspection is set out in full at Appendix I.

Terminology in this report

Our report contains references to ‘national’ bodies, strategies, policies, systems, responsibilities, processes and data. In some instances, ‘national’ means applying to England and Wales. In others, it means applying to England and Wales and Scotland, or the whole of the United Kingdom.

Section 1. Leadership, accountability and working with partners

Expected outcomes: Leadership, accountability and working with partners

Chief officers have a clear priority to protect the safety and well-being of detainees and to divert vulnerable people away from custody.

Leadership

Gwent Police has a clear governance structure for safely and respectfully providing custody services. An assistant chief constable, supported by a chief superintendent, has overall responsibility for custody services. A superintendent and a chief inspector are responsible for the day-to-day management of the two suites.

There are limited strategic and operational governance arrangements to oversee custody. A strategic force performance board meeting, chaired by an assistant chief constable, provides some governance and oversight of custody data, but this data is high level – for example, total throughput, total refused detentions, total strip searches and some disproportionality data. There are no other formal meetings that scrutinise custody services and their quality at the force level or the custody management level.

The limited governance and oversight of custody means there are some critical weaknesses in the way the force provides custody services. Some of the recommendations from our last inspection, which was in 2017, haven’t been achieved or have only partly been achieved, leaving some key areas of custody needing urgent attention. These include governance, managing and overseeing custody services, and overseeing the use of force, risk management and mental health. Together, these areas are a cause of concern.

The oversight and governance of healthcare is weak. The force directly employs HCPs, and a lead nurse supervises them day to day. But the force has recognised that it isn’t qualified or experienced enough to provide clinical governance, and it decided to contract out this governance to make sure it meets all detainees’ health needs. The new healthcare provider will employ the HCPs directly and provide this governance when the contract begins, at a date to be confirmed.

At the time of our inspection, Ystrad Mynach custody suite was closed for extensive renovations and improvements. The investment into improving the facilities at Ystrad Mynach shows the force’s ambition to have facilities that are safe, compliant with legislation, and that provide a better environment for both detainees and custody personnel.

The force responded quickly to our feedback during the inspection, and it made commitments in several areas – for example, deciding to install sinks in cells at Ystrad Mynach. This gives us confidence that custody services, and outcomes for detainees, will improve.

While renovations are underway at Ystrad Mynach, the force provides custody services at only one suite, Newport. This will become a contingency suite when Ystrad Mynach re-opens. Newport custody suite is staffed by 2 custody inspectors, 20 custody officers and 40 detention officers. There are enough personnel to provide custody services, but the number of inspectors and the requirements for them to carry out all reviews of detention as per section 40 of PACE when on duty means they can’t carry out other core functions and effectively oversee the day-to-day running of the suite.

Newport custody suite is well maintained, but there were some potential ligature points around cell door frames. We found similar ligature points at Ystrad Mynach, where we could examine some cells despite the building works. We gave the force an illustrative report citing all potential ligature points, as well as feedback on its general conditions.

Custody officers and detention officers receive the nationally approved initial custody training and are mentored by more experienced officers before taking up their role. But continuing professional development training has been limited, with only one day per year available for custody personnel. Senior leaders and custody personnel told us they hadn’t received any training in the past 18 months, other than first aid and officer safety training. They couldn’t recall the content of previous training, but some personnel attended No Boundaries, a force-wide half-day training event on race awareness. Custody personnel told us they would welcome more training and awareness in areas such as mental health, neurodiversity, gender reassignment and dealing with children in custody.

The force has adopted the College of Policing’s APP, but members of the workforce don’t always follow it. This contributes to the inconsistent practices we saw in our inspection, such as:

• removing cords and laces from detainees without carrying out individualised risk assessments;
• setting appropriate observation levels to intoxicated detainees; and
• not completing logs during level 3 and 4 observations and handover procedures.

Adverse incidents that happen in custody are reported and recorded. The force shares learning from incidents directly with the officers involved and with all other custody personnel by email.

There have been no deaths in custody since our last inspection, which was in 2017.

Accountability

Members of the strategic performance board monitor performance, assessing the number of detainees entering custody, waiting times, children in custody, and strip searching. But there are no performance meetings or performance reports at the custody leadership level. This forms part of our cause of concern.

There is no performance framework or regular performance scrutiny to assess how well the force provides custody services. This means it can’t identify any underperformance and therefore can’t put in place measures to make improvements over time. The force could provide some of the information we asked for, but some important information was missing – for example, the time children and vulnerable adults wait for support from an AA, waiting times for mental health assessments, and how long those in mental health crisis remain in custody. Officers don’t routinely monitor this information, and often they don’t record it clearly on custody records, so the force can’t determine how well it is meeting detainees’ needs.

Some information is inaccurate, especially that relating to the use of force in custody. For example, there is minimal recording on custody records to show when force was used, who used it and why it was necessary. Not all officers are completing use of force forms, as is required by guidance from the NPCC. There is little quality assurance of incidents or monitoring of the use of force at a strategic or operational level, and no custody-specific external scrutiny, using CCTV reviews, of the use of force. The limited scrutiny that does take place is hindered by inaccurate information and poor CCTV coverage. This means the force can’t show that when it uses force or restraint in custody, it is necessary, justified and proportionate. However, in the 18 use of force cases we assessed, most techniques used were appropriate, which is positive.

The quality of recording on custody records isn’t consistently good enough. While we saw some detailed entries on custody records, important information isn’t always recorded – for example, risk assessments, reviews of detention, and the justification for removing detainees’ clothing.

The force doesn’t always meet the requirements and guidance set out in PACE, its codes of practice and other legislation. For example:

• it doesn’t inform detainees when a review has taken place when they were asleep (paragraph 15.7 of PACE code C);
• it doesn’t carry out or record all reviews of detention correctly (paragraphs
  0–15.5 of PACE code C); and
• it doesn’t always assign girls in custody to the care of a woman, which is a requirement of section 31 of the Children and Young Persons Act 1933 (also paragraph 3.20A of PACE code C).

There is no formal quality assurance process. Custody inspectors try to dip sample ten records each month, but they don’t record the findings. This means they can’t identify themes or use the review process to improve performance.

The force understands the public sector equality duty, but custody personnel told us they had received minimal training in identifying and managing the diverse needs of detainees. The force monitors disproportionality in some custody services to assess whether outcomes for detainees are fair. It monitors data on detainee throughput, total numbers of strip searches, refused bail and detention lengths to identify any potential disproportionality by age, gender and ethnicity. The members of the quarterly external scrutiny panel, which includes members of the independent advisory group, discuss this data. This is positive.

The force is also open to external scrutiny from its independent custody visitors (ICVs), who visit the suite weekly. Custody personnel are responsive in addressing any concerns or problems that the ICVs raise. The ICV co-ordinator has a good working relationship with custody managers and any concerns are discussed during regular panel meetings.

Working with partners

The force works well with other organisations in meeting statutory responsibilities to improve outcomes for children and those with mental health conditions. However, limited resources make it difficult to meet the needs of children and those with mental health conditions.

There is a clear priority to divert children away from custody. Joint work with the youth offending teams, Welsh Government and the Probation Service is aimed at making sure children are kept safe from harm, aren’t kept in custody for longer than necessary, and re-offending is prevented or minimised. Children are discussed at meetings such as the Gwent monitoring review panel, the child-centred strategic steering group and the local safeguarding board. But local authorities can rarely provide other accommodation for children who are charged and remanded, so they aren’t moved from custody as they should be.

The force doesn’t monitor the number of mental health assessments carried out in custody or how long it takes to arrange them. It is unclear what work it has done with mental health services for detainees who need this support. Due to this lack of scrutiny and understanding, the force and its partners aren’t making improvements, and outcomes for those needing assessments in custody remain poor.

Section 2. Pre-custody – first point of contact

Expected outcomes: Pre-custody – first point of contact

Police officers and staff actively consider alternatives to custody. They effectively identify vulnerabilities that may increase individuals’ risk of harm. They divert children and vulnerable adults away from custody when detention may not be appropriate.

Assessment and diversion at first point of contact

Frontline officers have a good understanding of what makes a person vulnerable, and they take account of this when deciding whether to make an arrest or deal with the incident in another way. They consider factors such as age, mental ill health, learning difficulties and financial problems. They also consider whether there are any potential harm concerns that might mean an arrest is needed to protect the person involved in the offence, or any others. Officers have received some training on recognising vulnerabilities, including neurodiversity and mental ill health.

Officers told us that information from call handlers (who take calls from the public) about incidents and any people involved is generally good. Demand in the control room means this information can sometimes take a long time to reach officers and is occasionally not passed on at all. But overall, officers felt they have enough information to make informed decisions.

Frontline officers try to divert children away from custody when possible, and they only arrest children when no alternatives are available. They consider:

• arranging to interview the child later, outside custody;
• using community resolutions; and
• referring the child to the youth offending team, which can offer support and intervention activities.

Officers told us they feel well supported when dealing with people with mental health conditions. They receive support from a mental health triage service, which is in the control room and is staffed between 8am and 2am daily. Mental health professionals check health records, give advice and speak directly to officers or the detainee if needed.

Officers value this service and said it helps them make informed decisions about what to do, and whether they should detain a person under section 136 of the Mental Health Act 1983 for their own or others’ safety. In their view, the service helps avoid some section 136 detentions because alternative health arrangements are sometimes made instead.

When a person is detained under section 136 in a public place, the mental health professionals help officers further by liaising with the health-based place of safety at St Cadoc’s Hospital to arrange a Mental Health Act assessment and bed space. But officers told us that when a detainee needs a mental health assessment, there is regularly a long wait. This is a poor outcome for detainees and a poor use of police time.

The force doesn’t use custody as a place of safety for section 136 detainees. When a person has committed an offence, officers arrest them unless there are clear mental health concerns. Any subsequent concerns are dealt with in custody. If the need for a Mental Health Act assessment is identified, it is carried out while the detained person is in custody.

Section 3. In the custody suite – booking‑in, individual needs and legal rights

Expected outcomes: In the custody suite – booking‑in, individual needs and legal rights

Detainees are treated respectfully in the custody suite and their individual needs are identified and met. Detainees’ risks are identified at the earliest opportunity and managed effectively. Detention is appropriately authorised. Detainees are informed of their legal rights and can freely exercise these rights while in custody.

Respect

Custody personnel are respectful and show empathy and understanding in their interactions with detainees.

Custody officers reassure detainees during booking-in and explain what will happen while they are in custody. All detainees we saw being booked in were offered the chance to speak to someone in private about their health and well-being, or to disclose confidential information.

The design of the suite in Newport means there is limited privacy at the booking-in area, and the environment can be noisy when more than one detainee is booked in at the same time.

There is CCTV in the suite, including in the cells. This is explained to detainees during booking-in and they are told that the toilet area is obscured from view. But several toilets weren’t pixellated correctly on screen, which affects detainees’ dignity and privacy. We pointed this out to the force at the time of the physical conditions checks and it told us it would make the appropriate improvements.

The shower in the Newport suite doesn’t offer enough privacy. Custody personnel complete safety checks by looking through a spyhole, which means the detainee is fully visible when showering. This is inappropriate.

Meeting diverse and individual needs

The custody suite in Newport has some facilities to meet the needs of detainees with disabilities that affect their mobility, hearing or sight. For example:

• there are two wheelchairs in good condition;
• some cells have sight lines to help detainees with visual impairments;
• there is a hearing loop for those with auditory impairments;
• there is an adapted toilet and shower;
• some cells have high benches;
• there are extra-thick mattresses; and
• the exercise yard is step free.

In addition to the above, custody personnel make individual adjustments when detainees need them. For example, during our inspection, we saw that a detainee could use their own wheelchair.

There are Braille and easy-read versions of rights and entitlements in the suite. There are also leaflets for children and vulnerable adults explaining what they can expect in custody, which may help make them feel less anxious. There are no cells specifically for children, but custody officers told us they try to place them away from adults when possible. Some of the cells have glass panes in the door. This can help manage anxious detainees’ needs as it means they can see what is happening outside the cell. Custody personnel showed a reasonable knowledge of neurodiversity, despite having had limited training.

The force meets the needs of women as best it can. During booking-in, female detainees are asked if they need feminine hygiene products. There is also a menopause pack available for those who may benefit from it. But there are no sinks in any of the cells, so detainees have to ask to be taken to the shower area to wash their hands. This means there may be a wait if the suite is busy, and not having a sink isn’t hygienic.

Detainees can observe their faith while in custody. There is an extensive range of religious items relating to the major religions. All religious texts and materials are appropriately wrapped and stored.

The force uses LanguageLine to provide interpreters for detainees who speak little or no English. There are twin telephone points for when interpreters need to be called at the booking-in desk, but we were told these weren’t working. This makes interpretation at the booking-in area very difficult and time-consuming as it means the custody officer and detainee have to share one phone.

Risk assessments

Frontline officers and custody officers generally identify detainee risk well. But the force doesn’t always follow APP guidance for risk management. This is a cause of concern.

When the suite is busy, detainees can spend a long time waiting in holding areas or police vehicles before being booked in, which is contrary to APP guidance. In our custody record analysis, we found waiting times of over an hour were common, with an average of 1 hour 11 minutes. This average waiting time is much higher than we normally find in our inspections, and it is a poor outcome for detainees.

The booking-in facilities in the Newport suite limit the number of detainees who can be booked in at any one time. This is due to a lack of privacy. But it isn’t always clear if this is the only reason for the long waits, and the force should carry out work to understand this better and improve detainees’ outcomes.

During our observations, we saw custody officers prioritising children for booking-in when the suite was busy. This is positive as children and vulnerable people should be assessed promptly.

Custody officers explain to detainees why a risk assessment is needed. They check previous custody records, Niche (the custody IT system) and the Police National Computer, and they ask escorting officers for relevant information to inform the initial risk assessment. The force uses a standard risk assessment template, which includes appropriate questions. But they mostly only require yes or no answers, and the template allows little free text recording, particularly for any health issues and risks officers have identified.

Custody officers set comprehensive care plans and review them at appropriate times. But in some cases, they don’t record the rationale for changes to care plans – for example, reduced observation levels.

Custody officers generally make appropriate referrals to the HCP, and the HCP sees detainees promptly. But when care plans include a requirement for the detainee to see the HCP, we found this sometimes didn’t happen, and there was no explanation recorded for this.

Observation levels don’t always reflect the risk posed. Our case audits showed custody officers generally place detainees under the influence of drink or drugs on level 2 observations as a minimum, as per APP. But in our use of force audits, we saw custody officers inappropriately placing some detainees on level 1 observations when intoxicated or having warning markers for self-harm.

Level 4 observations need improvement. Our audits showed that custody officers brief the observing officers, but officers carrying out the observations don’t complete a separate log. This practice doesn’t follow APP guidance. Level 3 observations take place in a room behind the custody desk, where there are too many distractions. This could make it difficult for the officer to carry out this task properly.

Custody personnel carry out good and timely rousing checks. Some personnel use generic entries when rousing detainees, rather than entering bespoke updates on the detention log. Checks are generally carried out by different detention officers, which doesn’t ensure continuity of care. This limits how well the force can evaluate any changes in the detainee’s condition and any potential risks.

Officers make paper detention logs when detainees are taken to hospital, but they don’t attach or scan them to custody records. We were told that custody officers pick out key points from the paper records and update them manually on the custody record, but only if they have time to do it. We observed one hospital log containing just two entries. Officers didn’t transfer either of them to the detention log as they didn’t consider them significant. This means the electronic custody record doesn’t necessarily reflect all aspects of a detainee’s detention.

Handovers don’t involve all custody personnel. The HCPs don’t attend the custody handover and one custody officer usually hands over to another, rather than all custody officers being present. This means the other custody officers may not always know about risks. This is contrary to APP guidance and is part of our cause of concern.

Not all custody officers, at the beginning of their shift, visit and speak to the detainees they are taking responsibility for. At the start of each shift, only one custody officer, one detention officer and an HCP visit the detainees, and the custody officer then updates care plans. This is poor practice.

At the time of booking-in, custody officers explain the cell call-bell system to detainees. During our observations in suites, we saw detention officers answering calls promptly.

All custody officers and staff carry anti-ligature knives.

Some custody officers routinely decide to remove detainees’ footwear. They don’t always cite the reasons for this on the custody record, which is contrary to PACE code C 2023, paragraph 4.5. We saw custody officers carrying out risk assessments to check for cords or other items of clothing that could be used as ligatures. But we also saw some custody officers removing belts and cords as a matter of course, so there doesn’t seem to be a consistent approach. This forms part of our cause of concern.

Individual legal rights – detention

When detainees are booked into custody, waiting times vary. We found some detainees were booked in promptly, within 30 minutes, while others waited more than an hour during busy periods. We saw some children being prioritised for booking-in, but this didn’t always happen.

The booking-in process is thorough, and custody officers clearly explain the procedures. They appropriately authorise detention. Arresting officers verbally give information about the circumstances of the arrest and explain why it is necessary (as required by PACE code G 2012). When the necessity for detention is unclear, custody officers ask further questions before authorising detention. If they consider that the necessity and proportionality criteria for arrest aren’t met, they are confident to refuse detention, and we saw this happening during our inspection.

The force uses voluntary attendance interviews to avoid taking a person into custody, and it conducts them outside the custody suite. There are enough facilities across the force area.

When officers can’t complete the investigation within the first period of detention, detainees are appropriately bailed or released under investigation. Custody officers explain to detainees the consequences of breaching bail conditions. We saw this happening during our inspection and in our audits.

Decisions to remand detainees post-charge are recorded on the custody record. The entries are detailed, with clear rationale as to why bail was denied.

When detainees are released under investigation, the custody officer explains the process and the requirement for the detainee not to contact victims while the investigation is ongoing.

Individual legal rights – detainees’ rights and entitlements

Custody officers clearly explain to detainees their rights and entitlements during booking-in. These include:

• to have someone informed of their arrest;
• to consult a solicitor and access free independent legal advice; and
• to consult the PACE codes of practice.

All detainees receive a leaflet that outlines these rights.

The force gives easy-read booklets to children and vulnerable adults who may benefit from them. We saw custody officers handing these to detainees who needed them.

There are enough copies of the most recent edition of PACE code C 2023 in the suite. There are posters advertising the right to free legal advice in Welsh but not in other languages.

Custody officers we spoke to were aware of the requirements of PACE code C, annex M, which states that detainees should receive documents and records on important information about custody processes in a language they can understand. We saw examples of these documents being given to foreign national detainees.

Custody officers we spoke to knew how to contact the relevant embassies, consulates or high commissions for foreign nationals coming into custody. Custody records for foreign national detainees showed consideration for the specific rights and force policy relating to foreign national detainees.

There are enough interview and consultation rooms for detainees to privately consult their legal representatives, and these are used appropriately.

Reviews of detention

Reviews of detention for detainees aren’t always carried out well enough.

In our custody record analysis and case audits, we found some good examples of PACE reviews completed with reference to the detainee’s specific circumstances. In these cases, the reviewing officer routinely established the investigation’s progress by speaking to investigating officers to help decide if continued detention was needed. Inspectors also reminded the detainee of their ongoing rights and entitlements, and considered their welfare.

But we also saw some poor reviews. Some were completed early, or late without an explanation why, and sometimes officers hadn’t spoken to the detainee as they had considered the detainee to be unfit. Some of these detainees were awaiting mental health assessments but weren’t detained under the Mental Health Act 1983 at the time of the review.

Most reviews were carried out at appropriate times, with few sleeping reviews taking place outside recognised rest periods.

When a review of detention takes place while a detainee is asleep, officers don’t always inform detainees that this has happened, or remind them of their rights and entitlements, at the earliest opportunity. This is required by PACE code C, paragraph 15.7.

Complaints

Detainees wishing to make a complaint while in custody aren’t always made aware of how to do this. Notices outlining how detainees can make a complaint are only displayed in corridors leading to the cells and not in a prominent position for detainees to see.

Custody personnel know the procedure if detainees want to make a complaint while in detention. There is an expectation from the senior leadership team that all complaints should be recorded at the time they are made, and that an inspector is informed. But the force doesn’t monitor if complaints are recorded while the detainee is in custody, so it can’t assure itself that it is following the complaints procedure. In our case audits, we found a complaint from a detainee didn’t appear to have been taken or recorded while they were in detention.

Section 4. In the custody cell – safeguarding and healthcare

Expected outcomes: In the custody cell – safeguarding and healthcare

Detainees are held in a safe and clean environment, which protects their safety during custody. If force is used on a detainee this is as a last resort. Their care needs are met, and children and vulnerable adults are protected from harm. They have their physical and mental health, and any substance misuse, needs met.

Physical environment

Gwent Police has two designated custody suites, in Newport and Ystrad Mynach. The force owns and maintains both buildings.

At the time of our inspection, Ystrad Mynach custody suite was closed due to extensive renovations. These will include more cells, a larger and more private booking-in area and a discrete booking-in room. Newport custody suite was the only operating custody suite. The suite in Newport will be closed when the Ystrad Mynach suite reopens in 2025, and the force plans to use Newport as a contingency suite in future.

Despite the extensive building works at Ystrad Mynach, some of the existing cells were available for us to inspect.

There are potential ligature points at both suites, mainly around cell door frames, and at Ystrad Mynach, we also found a potential ligature point under a cell bench. During our inspection, we gave the force a comprehensive illustrative report detailing these findings, as well as general information on the physical conditions in the suites.

In Newport, the ventilation and temperature in the suite and individual cells are satisfactory and there is some natural light in the cells. All cells have toilets, but no cells have sinks for handwashing or supplying drinking water. There are no sinks in the cells at Ystrad Mynach, but the force said it plans to install sinks during the current renovations. This is positive and will improve hygiene for detainees. It will also reduce work for detention officers, who otherwise would need to take detainees out of cells to communal sinks when needed.

There is only one shower in the Newport suite. It doesn’t have a door with a suitable design to allow for privacy, as well as safety observations by personnel. The shower room has a fully closing door with a spyhole. There is also a spyhole in the wall of the shower room. Detention officers can only carry out safety observations while a detainee is showering by looking through either spyhole. Viewing the detainee this way while they are showering isn’t appropriate.

The suite in Newport is generally clean. Suites are deep cleaned when needed. Custody personnel told us that most repairs are completed quickly. We found little graffiti.

The booking-in area at Newport is a poor environment for both detainees and personnel. There is no natural light, and there are no privacy barriers between booking-in desks. The space is open and noisy, especially when more than one detainee is booked in at the same time, which we frequently observed during our inspection. We noted that due to the ambient noise levels, detainees and custody personnel sometimes found it difficult to communicate with each other.

There is no discrete booking-in room, but custody personnel can use the search room if it isn’t in use when they need it. We saw them using this room when children were waiting to be booked in. The holding areas for detainees are separate from the booking-in areas.

Custody personnel told us they carry out regular checks of the suite to inspect conditions. But in these walk-throughs, they hadn’t found the ligature points we identified.

CCTV operates in the suites. There are signs telling detainees about this, but there could be more of them, and they could be placed more visibly in the booking-in area, where detainees can easily see them. The quality of the CCTV footage in the Newport suite is poor and needs to be improved.

CCTV monitors are in a separate room, where they can’t be viewed by anyone other than custody personnel. This is positive.

But the Newport suite doesn’t have an area that is quiet and free of distractions, where officers can carry out level 3 CCTV observations. The officers sit in a room behind the custody desks with other personnel carrying out their work, which means they can become distracted from these observation duties. This practice doesn’t follow APP guidance.

There is a good understanding of emergency evacuation procedures. Custody personnel we spoke to had received recent fire safety training and this included a practical fire evacuation. There were enough handcuffs for personnel to manage an evacuation.

Use of force

When force is used in custody, it is usually proportionate to the risk or threat posed. But there is poor recording of incidents and little quality assurance of the use of force, making it difficult for Gwent Police to show that when it uses force in custody, it is necessary, justified and proportionate. This forms part of our cause of concern.

We examined custody records and viewed CCTV footage relating to 18 cases in which force was used. We examined a further seven custody records relating to cases in which strip search was authorised, or detainees had clothing removed that could have been used to self-harm. Our CCTV review of the use of force on detainees in custody was hindered by a lack of audio in communal areas, and by poor-quality footage at the custody desks. Some camera lenses in cells were dirty and needed cleaning.

We saw some effective communication and negotiation by officers as they tried to de‑escalate situations. This sometimes avoided the need to use force. Officers used unarmed tactics proportionately and safely. They were patient and respectful towards aggressive or abusive detainees.

Of the 18 cases we reviewed in which officers used handcuffs, leg restraints or spit hoods, they mostly applied them correctly, when necessary, and they checked them regularly. But in one case, a detainee was handcuffed with their hands in front when a spit hood was applied, which meant the detainee could remove the spit hood.

We saw some detention officers involved in the use of force recording detailed detention logs, which explained what had happened and how they were involved. This is positive.

However, in the cases we reviewed, the overall recording of use of force incidents was poor. This was an area of concern in our last inspection, and it hasn’t improved enough. The force has a standard detention log for recording use of force incidents on the custody record, which follows the national decision model, but custody officers don’t always use it. Prompts in the custody system remind officers to record use of force incidents, but our custody audits and use of force data request showed these reminders haven’t been effective.

In 9 of the 18 cases, there was no record of force having been used in custody at all. And in three cases, the standard of the custody record entries was extremely poor because they didn’t include detail of what had happened, why force was necessary or what, if any, restraints officers had used.

Custody officers make a record when a detainee arrives in custody in handcuffs or other restraints such as a spit hood or leg restraints, but they don’t record the time of removal.

In five cases, we found detainees were restrained in cells having been placed in handcuffs, leg restraints or spit hoods during detention periods. In all these cases, detainees were appropriately placed on level 3 or level 4 close observations, but custody officers didn’t oversee this, and detainees were in restraints for too long. In three of these incidents, detainees spent between 1 hour 19 minutes and 2 hours 17 minutes restrained in cells. We found no evidence that custody officers had recorded the use of force or managed the length of time detainees were held in restraints to justify their continued use. We have referred these three cases to the force for learning.

Officers who use force on detainees in custody don’t always submit individual use of force forms as required by NPCC guidance. We asked for use of force forms for the incidents we reviewed but didn’t receive all the forms we were expecting. We expected 69 forms but only received 30. There are no posters displayed in custody reminding officers to submit use of force forms, and custody officers don’t regularly remind officers.

When detainees’ clothing is removed for safety reasons, the force records these incidents as strip searches in accordance with APP. The records we reviewed were appropriate to the risks identified. However, we found that the necessity and justification for a strip search under section 54 of PACE to search for concealed items wasn’t always clearly recorded on custody records. In three of the four section 54 strip search authorities we reviewed, we found a reliance on the detainees’ previous (Police National Computer) warning markers to justify the search. Some of these warning markers were old and the justification lacked information. We referred one case to the force for learning.

Most custody and detention officers are up to date with their officer safety and first aid training. The force had allocated courses to those who weren’t.

Detainee care

The force’s approach to detainee care is good. Custody personnel are considerate and do their best to meet detainees’ needs. The detainees we spoke to were positive about the care they received while in custody.

At the time of booking-in, custody officers inform detainees of a wide range of provisions available to them, such as exercise, shower and reading materials. Detainees are routinely asked at booking-in if they would like a book to read or if they would like any distraction materials, such as crossword puzzles or colouring books. Game Boy consoles are also available. We saw this recorded in our audits and we saw books and distraction materials being handed out during our inspection. However, there are limited books in foreign languages.

There is a good range of food available, covering most dietary requirements. The kitchen and food preparation areas are clean. Food and drink are regularly offered and provided, and this is recorded on the custody logs.

Showers are offered, especially to those attending court in the morning. There is a good range of toiletries and cloth towels available. Toilet paper is routinely provided on entry to the cells.

There is one exercise yard at Newport custody suite. This is step free and provides some cover in bad weather. We saw detainees using it during our inspection.

Replacement clothing, including underwear, is available in a range of sizes. Plimsolls in different sizes are also available.

The force provides a pillow and two thin mattresses in the cells. Some of the mattresses appeared worn, which may be due to the practice of folding them in half after cleaning. Detainees can also have a blanket if they want one.

Safeguarding children and vulnerable people

The force doesn’t have a specific safeguarding policy, and some safeguarding arrangements need clarifying. For example, the leadership team expects that a public protection notice for a child in custody is started by the custody officer. But custody officers we spoke to said that the arresting officer completes this document.

Custody personnel notify social services when a child is brought into custody so they can exchange risk information when necessary. During our observations in the suite, we saw good examples of custody officers considering the safeguarding needs of children and vulnerable adults, and making referrals for when they leave custody. We saw various custody personnel making good efforts to try to find a homeless detainee somewhere to stay on release.

All children are referred to the HCP for a juvenile assessment. HCPs can make safeguarding arrangements when needed, and during our audits, we saw this recorded on the custody logs.

A safeguarding board meeting provides some scrutiny over safeguarding referrals.

Appropriate adults

Custody personnel will first consider family, friends or other people known to the detainee to act as the appropriate adult (AA). When family members or friends cannot attend or aren’t suitable, the force uses the youth offending team for children from Monday to Friday, 9am to 5pm, and social services’ emergency duty team at any other time. AA provision for vulnerable adults is through Adferiad 24 hours a day.

There is an expectation that AAs should be contacted as soon as possible to support detainees at the earliest stage. We found some good examples of early contact with parents acting as AAs, both in our audits and in our observations in the suite. But when parents or relatives couldn’t act as AAs, this wasn’t always the case.

The provision of AAs for vulnerable adults is good. Custody personnel told us staff from Adferiad attend the suite around the clock. For children, there is generally good provision from the youth offending team during working hours. But custody personnel said the emergency duty team usually only has one duty worker on shift, and that person covers the whole of Gwent, so it can be difficult to arrange for an AA for children to attend the suite in person out of hours.

Rights and entitlements are sometimes explained over the phone when the AA isn’t able to come to the suite straight away. But not having an AA at the interview in person can lead to children being detained for longer than necessary, and this is a poor outcome for them.

The force doesn’t monitor how long it takes for an AA to arrive and therefore can’t assure itself that support is always given at the earliest time, or that the arrangements for AA provision are effective. This hasn’t been progressed since our last inspection.

Written guidance for AAs is available and routinely provided. But we told the force that this information needs to be updated to reflect the fact that children under 18 (rather than under 17) should receive AA support.

Children

The force has a clear approach to diverting children away from custody when possible. It uses voluntary attendance and early social services intervention as an alternative to custody. But when it needs to detain a child, there is a good focus on the child’s welfare and on trying to minimise the time in custody.

The force expects children to be prioritised for booking-in. We saw this happening during our observations in the suite, but not in every case. In our audits of children’s records, we found some children waited a long time to be booked in, so it isn’t clear if children are always prioritised.

Custody officers told us they felt confident to refuse detention for a child or vulnerable adult who could be dealt with outside custody, and during our inspection, we saw examples of this happening.

The force expects children brought into custody to be dealt with expeditiously, and custody officers frequently check with investigating officers on the progress of the case.

Children charged and remanded aren’t usually moved to local authority accommodation overnight. Data provided by the force shows that, in the year before our inspection, nine referrals were made for local authority accommodation, and only one was successful. This is a poor outcome for children charged and refused bail.

Custody officers didn’t always record whether a same-sex member of the workforce was assigned to girls under 18, as required by the Children and Young Persons Act 1933. This is also an area that the force doesn’t monitor. It therefore can’t assure itself that it always allocates a female carer. This was an area for improvement in our last inspection and it hasn’t improved.

Custody personnel show a good level of care towards children. They offer and provide food and drink regularly, and there are distraction materials available for those who may benefit from them. These include Game Boys, fidget spinners and foam balls. Children can spend time outside their cell, in the exercise yard, and we were told that visits from family members can be accommodated.

There is a leaflet for children that explains in detail what happens in custody. This may help to reduce anxiety. We saw this being offered to every child at the time of booking‑in.

There is some scrutiny over children in custody. For example, the local safeguarding board looks at child strip searches and public protection notices. A child-centred strategic group looks at the well-being of children and onward referrals to agencies that can assist children on release. There is also a monthly monitoring and review panel for children held overnight in custody. But the force could do more to further scrutinise outcomes for children in custody, such as by carrying out more robust dip‑sampling of children’s records. This should include examining how long it takes for AAs to attend and whether girls have been assigned a female carer.

Healthcare

Healthcare is provided directly by Gwent Police, which employs a range of HCPs to fulfil this service.

The superintendent oversees clinical healthcare governance, and quarterly meetings take place with the lead nurse. But this process isn’t sufficiently robust. Although the lead nurse has one-to-one meetings with the chief inspector and has access to clinical support via a medical practitioner, there is no clinical supervision. The force anticipates that this issue will be resolved by Mitie, which is taking over the contract to provide physical and psychological healthcare support to detainees and to carry out forensic testing in custody.

Skilled staff, including registered nurses and 3 paramedics, provide appropriate clinical assessment and treatment for detainees 24 hours a day. There are usually two healthcare staff working in the custody suite throughout this period. Agency staff cover any deficits the force identifies.

HCPs have access to good training and professional development opportunities to maintain and enhance their clinical skills. Training has included Immediate Life Support and Enhanced First Aider training, and paramedics have completed Advanced Life Support. Staff we spoke to said they felt supported by, and receive clinical supervision from, the lead nurse. Custody healthcare staff have 24-hour telephone access, via a dedicated call centre, to a forensic medical examiner advisory service.

HCPs prioritise detainees who need forensic samples, and cases in which risk dictates an urgent need for assessment. But the force doesn’t have set response times for HCPs to see detainees, and there is no governance process to make sure this prioritisation takes place, or to monitor it.

The force works well with healthcare partners and there is effective communication to improve health outcomes for detainees. HCPs have access to a range of organisations providing support and advice. This collaborative working helps to improve outcomes for detainees in terms of them having timely access to services.

Outgoing HCPs give a written handover to the incoming healthcare team at the end of their shift. We found these handovers to be very comprehensive, covering important information such as detainees’ medical history, medication prescribed and when due, and a record of progress of any outstanding actions.

HCPs accompany the custody officers every morning and evening on a walkaround to visit all detainees. But they don’t attend the handover meeting with custody personnel, so officers may not be receiving vital clinical information as quickly as they could.

The lead nurse looks into complaints involving healthcare. Detainees receive leaflets telling them how they can make a complaint. However, the confidential health complaints system isn’t well advertised as there are very few posters in the suite displaying the complaints process.

Physical health

Experienced and competent healthcare practitioners provide treatment for detainees.

With the detainee’s consent, HCPs assess physical health and make sure any prescribed medication is available while the detainee is in custody. There is a record of detainees’ assessment and treatment on the electronic clinical record. The HCPs don’t have direct access to the health board’s individual patient records, but they access this information through the criminal justice liaison team and the Gwent Police mental health triage team, based in the headquarters of the force’s communication centre. This makes sure HCPs know about detainees’ healthcare needs and can contribute to decisions about risk, and fitness to detain, interview or release.

Healthcare consultations are generally private. But the only clinical room is very congested with chairs and medicine cupboards, and we found it to be very busy. The clinical room doesn’t have an examination couch. We were told that if a patient needs a couch, there is one in the sterile/forensic room that they can use.

Medical handovers between healthcare staff showed that HCPs adequately record information on aspects of physical healthcare including wounds, hypertension and diabetes.

Mental health

From Monday to Friday, 9am to 5pm, detainees with mental health conditions are seen by members of the criminal justice liaison team, who are employed directly by Aneurin Bevan University Health Board. Outside these hours, detainees can see the emergency duty team if they need a Mental Health Act assessment.

There is good support for frontline officers when dealing with people experiencing mental health conditions. A mental health triage manager leads a team of five mental health professionals, including approved mental health practitioners, within the force communications and control suite. This team operates 7 days a week, from 8am to 2am. Staff have access to the Aneurin Bevan University Health Board patient database, so they can see if someone has a history of mental ill health and then advise accordingly. The team is also a point of contact for custody healthcare staff when needed.

There is only one section 136 suite in Gwent and this is at St Cadoc’s Hospital in Caerleon, near Newport. Force data shows there weren’t any section 136 admissions to the police custody unit in the period from 1 August 2023 to 31 July 2024 and custody hadn’t been used as place of safety. But we didn’t receive any data on whether section 136 was used while a person was already in custody.

If a person is detained under section 136 and attends the Grange University Hospital in Cwmbran for a physical injury, only the physical injury is dealt with, even though there is a mental health team at the hospital. This means people with mental ill health are delayed from going to the section 136 suite, which may delay their access to appropriate care.

There is a good working relationship between the force mental health lead and health and social care services, and they focus on working together to resolve and manage any difficulties. But the force doesn’t monitor the waiting times for any detainees that are referred for a Mental Health Act assessment and need to be transferred from custody to a mental health hospital. This means it doesn’t know how effective its arrangements with partner agencies are.

The force offers detainees information on the support that will be available to them after release.

Substance misuse

Gwent Drug & Alcohol Service provides a range of support services to detainees with substance misuse issues, and a needle exchange service is in place at Newport Central Police Station.

The G4S criminal justice early intervention team attends Newport custody suite daily to see all detainees, regardless of whether or not they have a history of drug and alcohol abuse. The team carries out an initial assessment and, when needed, treatment for detainees experiencing drug and alcohol withdrawal while in custody.

For detainees with a dual diagnosis (mental ill health and substance misuse), there is good joined-up working and co-ordination between the criminal justice liaison team, which focuses on detainees with mental health conditions, and the criminal justice early intervention team. Staff from drug and alcohol services share information and work with the HCPs in the custody suite.

Detainees have access to prescribed medication for opiate substitute medication throughout their time in custody. We saw several examples of police officers helping to collect detainees’ medication either from their home or from a pharmacy, for those who needed it.

Medicines management

Patient group directions are in place, which means nurses can administer a comprehensive range of medicines without undue delay.

Two controlled drugs are in stock, and they are checked every day. All other medication is checked weekly. HCPs use appropriate systems and processes to safely administer, record and store medicines, including controlled drugs. There is a locked medical cabinet behind the custody desk, containing a denature kit for destroying any medicines.

The emergency equipment and drugs bag is checked weekly. We found it was well organised and contained separate bags of specific equipment.

When detainees go to court, their own medicines are transported with them. When possible, detainees who don’t have their own supply of medicines are given any required medication before leaving custody to go to court.

Section 5. Release and transfer from custody

Expected outcomes: Release and transfer from custody

Detainees are released or transferred from custody safely. Those due to appear in court in person or by video do so promptly.

Safe release and transfer arrangements

There is a clear focus on making sure detainees are released safely. But custody officers don’t oversee the completion of digital person escort record forms well enough.

Custody officers communicate well with detainees before their release. They complete and record a thorough pre-release risk assessment in the presence of the detainee.

The pre-release risk assessment is started when a detainee is booked into custody and is updated during the period of detention if further risks or concerns become apparent. We saw custody officers writing bespoke entries in the free text box for each detainee, and recording important information to help identify and manage risks when detainees are released.

Custody officers clearly understand vulnerability and, when necessary, relevant agencies are involved to support the release of vulnerable people. For example, we observed a 16-year-old released to social services accommodation due to family difficulties. The force often uses police transportation to take detainees home or to a safe place after their release.

Custody officers explain bail and any associated conditions well. They fully explain to detainees the consequences of breaching bail conditions and failing to surrender to bail. They also provide detainees with information about support organisations that can help them after release.

However, when detainees are transferred to court, custody officers don’t ask many questions about risks following release. But they check how detainees are feeling and whether they need to see an HCP before going to court.

Custody detention officers complete digital person escort records and arrange transport for detainees who are attending court, or for those recalled to prison. They generally complete these records well and include relevant risk, health and medication information. But sometimes important risk, health and medication information is missing from the digital person escort record. Custody officers don’t have enough oversight of the completion of these forms. They don’t check them and don’t know what information the forms contain. This practice doesn’t follow APP guidance.

Courts

Arrangements for detainees to attend court generally work well.

When detainees are remanded, they are usually transferred, in person, to the next available court. The force’s contractor for escorting detainees to court attends the custody suite each morning. Separate transport is provided for child detainees.

Detainees remanded or arrested on warrant during the day can sometimes appear before the court later the same day. Custody officers contact the courts throughout the day to find out if they will take additional detainees. We were told there was some flexibility between court and custody personnel to achieve this. The force can use police vehicles to transport detainees to court, which means they don’t have to wait for the contractor. This minimises their time in police custody.

The force uses video link facilities when necessary.

Section 6. Summary of causes of concern, recommendations and areas for improvement

Causes of concern and recommendations

Areas for improvement

In the custody suite – booking-in, individual needs and legal rights

In the custody cell – safeguarding and healthcare

Release and transfer from custody

Section 7. Appendices

Appendix I – Methodology

Police custody inspections focus on the experience of, and outcomes for, detainees from their first point of contact with the police and throughout their time in custody to their release. We visit the force over two weeks. Our methodology includes the following elements, which inform our assessments against the criteria set out in our ‘Expectations for police custody’.

Document review

Forces are asked to provide various important documents for us to review. These include:

• the custody policy and/or any supporting policies, such as the use of force;
• health provision policies;
• joint protocols with local authorities;
• staff training information, including officer safety training;
• minutes of any strategic and operational meetings for custody;
• partnership meeting minutes;
• equality action plans;
• complaints relating to custody in the six months before the inspection; and
• performance management information.

We also request important documents, including performance data, from commissioners and providers of health services in the custody suites and providers of in-reach health services in custody suites, such as crisis mental health and substance misuse services.

Data review

Forces are asked to complete a data collection template based on police custody data for the previous 36 months. The template requests a range of information, including:

• custody population and throughput;
• the number of voluntary attendees;
• the average time in detention;
• children; and
• detainees with mental health problems.

This information is analysed and used to provide background information and to help assess how well the force performs against some main areas of activity.

Custody record analysis

We analyse a sample of custody records drawn from all detainees entering custody over a one-week period prior to the start of our inspection. The records are stratified to reflect throughput at each custody suite and are then picked at random. Our analysis focuses on the legal rights and treatment and conditions of the detainee.

Case audits

We audit around 40 case records in detail (the number may increase depending on the size and throughput of the force inspected). We do this to assess how well the force manages vulnerable detainees and specific elements of the custody process. These include examining records for children, individuals with mental health problems, those under the influence of drugs and/or alcohol, and cases where force has been used on a detainee.

Our audits examine a range of factors to assess how well detainees are treated and cared for in custody. Audits examine, for example, the quality of risk assessments, whether observation levels are met, the quality and timing of PACE reviews, whether children and vulnerable adults get support from appropriate adults when they need it, and whether detainees are released safely. We also assess whether force used against a detainee is proportionate and justified, and is properly recorded.

Observations in custody suites

Inspectors spend a significant amount of their time during the inspection in custody suites assessing their physical conditions, observing operational practices, and assessing how detainees are treated. We speak directly to operational custody officers and staff, and to detainees to hear their experience first-hand. We also speak to other non-custody police officers, solicitors, health professionals and other visitors to custody to get their views on how custody services operate. We examine custody records and other relevant documents held in the custody suite to assess how detainees are dealt with, and whether policies and procedures are followed.

Interviews with personnel

During the inspection we interview officers from the force. These include:

• chief officers responsible for custody;
• custody inspectors; and
• officers with lead responsibility for areas such as mental health or equality and diversity.

We speak to people involved in commissioning and running health, substance misuse and mental health services in the suites and in relevant community services, such as local Mental Health Act section 136 suites. We also speak to the co‑ordinator for the Independent Custody Visitor scheme for the force.

Focus groups

During the inspection we hold focus groups with frontline response officers and response sergeants. The information gathered informs our assessment of how well the force diverts vulnerable people and children from custody at the first point of contact.

Feedback to force

The inspection team provides an initial outline assessment to the force at the end of the inspection, to give it the opportunity to understand and address any concerns at the earliest opportunity. Then we publish our report within four months giving our detailed findings and recommendations for improvement. The force is expected to develop an action plan in response to our findings, and we make a further visit about one year after our inspection to assess progress against our recommendations.

Appendix II – Inspection team

• Ian Smith: HMICFRS inspection lead
• Nicola Duffy: HMICFRS inspection officer
• Justine Wilson: HMICFRS inspection officer
• Sarah Edgar: HMICFRS inspection officer
• Emmanuelle Versmessen: HMICFRS inspection officer
• Andrew Reed: HMICFRS inspection officer
• John Powell: Health Inspectorate Wales head of mental health, clinical advice

Fact page

Note: Data supplied by the force.

Force

Gwent Police

Chief constable

Mark Hobrough

Police and crime commissioner

Jane Mudd

Geographical area

Blaenau Gwent, Caerphilly, Monmouthshire, Newport, Torfaen

Date of last police custody inspection

10–20 July 2017

Custody suites

• Newport Central Police Station
• Ystrad Mynach Police Station (closed for refurbishment at the time of our inspection)

Annual custody throughput

1 August 2023–31 July 2024: 9,022

Custody staffing

• Two custody inspectors
• 20 custody sergeants
• 40 custody detention officers
• Three bail sergeants

Health service provider

The force employs medical professionals as full-time members of its workforce.

Back to publication

Report on an inspection visit to police custody suites in Gwent Police