Challenging the Hospital ‘Missing Person’
Question: When is a missing person not really a missing person?
Answer: Well, that’s a little more complicated but am sure by the end of this blog we can agree on at least one thing:
If the only reason an agency is reporting a person ‘missing’ is because of a ‘protocol’ then they are probably not missing…. and we should be robust enough to challenge that.
A number of agencies report people ‘missing’ in accordance with a protocol: Care homes when children miss their designated curfew, drug and alcohol counsellors when they can’t get in contact with a service user, and the agency we will deal with today, the NHS when they can’t find a patient.
Let me say from the off, there are times when the NHS report genuine missing persons to us. Detained patients that have managed to abscond from their ward for instance, or suicidal patients that have waited so long to be seen that they have gotten frustrated and walked out and are reported to us to now find.
Essentially it comes down to us risk assessing each circumstance as to whether they are really ‘missing’ or not. It would be good however if this policy on assessing risk was perhaps done by the NHS before attempting to pass responsibility for these individuals to the police.
Because there is a particular category of NHS ‘missing’ that we need to push back against: Those that are reported because ‘it’s protocol’. These involve some combination of the following:
- Voluntarily absconded from a ward.
- Checked out without signing discharge paperwork
- Left with a cannula still in their arm.
The police are requested to ‘Bring them back to the ward’.
The observant amongst you will start to see the issue here:
Where is the risk? And more importantly….
What can or should the police do about it?
Lets deal with risk first. More often than not the call log doesn’t offer enough information to assess risk. This requires the frontline leader to call the reporter to ask questions about the patient.
This quick call to the reporter, often the charge nurse on the reporting ward, regularly establishes the following:
- No immediate concerns for the misper.
- No risk to life.
- No chance of catastrophic bleeding if they remove the cannula.
- No requirement for police to call an ambulance to get them medical treatment when found.
- No issue of capacity.
- No order in place to require a return to hospital.
The conversation invariably leads to the question: ‘Why are you reporting them missing?’ to which the answer is:
‘It’s our protocol..’
What do we think of this? Is this sounding like a missing person that should have police asset assigned to locate?
Turning to what the police can do about it. Well, not much really. There is no order in place to return the patient. There is no requirement for medical treatment. So essentially the NHS are asking us to find a patient that has decided to leave the hospital and has the capacity to make that decision and ask them to return…….
Is this really what we would consider a missing person? Those non-police reading the blog probably think the circumstances I have outlined above are few and far between. Not the case. The above example and variations of it make up a high percentage of missing person calls we receive from the NHS.
Police NHS liaison officers would do well to work with their local trusts to review these policies in order to tighten up the reporting circumstances and require a reasonable risk assessment to be conducted prior to reporting with a clear idea of what actions police are requested to take, mindful of the limitations of police involvement.
Until then frontline police leaders should be robustly challenging and documenting discussions with the NHS reporters rather than simply accepting the misper call and actioning limited police resources to it.
There will always be times when we move rapidly to establish the whereabouts of missing patients when the risk presents. However a policy to report patients who have voluntarily left the hospital due to protocol wastes everybody’s time and resources.