Neal Saunders

Mrs Heidi J. Connor 
Senior Coroner for Berkshire 

by email 

   9th February 2023 

Dear Mrs Connor 

Regulation 28 report, Neal Terence Saunders 

Thank you for providing the College of Policing with your Regulation 28 report in respect of the 
tragic death of Neal Terence Saunders.  

I would like to assure you that we take the recommendations in your report extremely seriously 
and will ensure that the learning from this incident is incorporated into our training and guidance.  

The College is currently implementing a new mandatory training package for Public and Personal 
Safety Training (PPST) along with an updated national curriculum and Authorised Professional 
Practice (APP).  The nationwide roll out of this programme will commence in April 2023 and all 
forces  must  achieve  implementation  by  April  2024.    This  will  result  in  police  forces  delivering 
PPST  to  a  common  national  standard  which  will  be  subject  to  an  ongoing  quality  assurance 
process by the College.  The training is a two-day annual package which is delivered in person 
and is focused on supporting learners with information retention. 

The  new PPST  has  a  strong  focus  on  de-escalation  and  communication  skills.  The  training  is 
based around scenarios which incorporate identifying and managing vulnerability, dealing with 
signs of medical emergency and requesting appropriate medical emergency responses.  This will 
include important content to equip officers and staff to recognise and respond appropriately when 
faced with ABD.  

In respect of the six points in your report, our response is as follows: 

1.  ‘Prolonged restraint’ is not currently defined.  This issue has been tabled for discussion at 
the national Clinical Governance Panel and we will look at ways to use clinical expertise 
to inform work in conjunction with College PPST leads.  

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 2.  The new PPST content will be clear that the guidance applies to those who are restrained 

in any circumstances, including people who are under arrest.  

3.  We will ensure that the revised training and guidance makes it clear that the response from 
the ambulance service is a matter for them, and the important point for policing is to ensure 
that  relevant  information  is  communicated  so  that  ambulance  despatchers  can  make 
appropriate decisions on prioritisation.  

4.  References to ‘chemical sedation’ will be removed from training. 

5.  & 6.  The new PPST delivery has been carefully developed and refined following a 12-

month pilot.  We are confident that this will be an improvement on previous training and 
will deliver a nationally consistent approach.  

The aforementioned new scenario based training is designed in order to ‘embed’ learning 
and make the training true to life. 

Yours sincerely, 

Chief Executive Officer 
College of Policing

South Central Ambulance Service NHS Trust 
Unit 7 & 8 Talisman Business Park 
Talisman Road 
Bicester, Oxon 
OX26 6HR 
Tel: 01869 365000 

9th February 2023 

PRIVATE AND CONFIDENTIAL 
Mrs Heidi Connor 
HM Senior Coroner for Berkshire 

Dear Mrs Connor 

We are writing to you in response to the concerns that you highlighted following the inquest hearing into 
the sad death of Neal Saunders that concluded on 2nd December 2022. Thank you for allowing us the time 
to review and respond to your concerns.   

To confirm,  your  Regulation  28  report  was  predominantly  aimed  at  the  national  bodies  responsible for 
providing training and guidance to police and ambulance service emergency personnel. Within that report, 
you asked the South Central Ambulance Service to consider working jointly with Thames Valley Police 
(TVP) to review our policies and training as suggested by our Medical Director during the evidence he 
provided to you.     

I  am  pleased  to  inform  you  that  in  addition  to  meeting  with  representatives  from  TVP,  we  have  also 
participated  in  discussions  with  representatives  from  the  College  of  Policing  and  the  Association  of 
Ambulance Chief Executives in relation to the written Joint Royal Colleges Ambulance Liaison Committee 
(JRCALC) UK ambulance service clinical practice guidelines provided to ambulance staff and the training 
slides delivered to police officers.  

Accessing JRCALC guidelines.  

As you will be aware from previous correspondence and engagement with the Trust, we provide our staff 
access to the JRCALC guidelines via the mobile APP. This ensures that they are able to access the most 
up to date version of the guidance for any condition or set of circumstances they may be presented with 
when they are with the patient they are treating. Whilst it was apparent during the evidence that you heard 
that the paramedic involved in this specific case, who worked for a private provider rather than the Trust, 
was not aware of some of the specific wording of the guidelines, he was aware that placing someone in a 
prone position should be avoided generally. From our review, there is no evidence that staff employed by 
the Trust have experienced any difficulties in accessing the guidance whether due to them being unaware 
of how to or because of technical difficulties in doing so. We are therefore confident that staff will always 
be able to review the guidelines when necessary.  

Guidance regarding restraint.  

We  are  aware  that  nationally,  there  is  not  a  definition  of  what  would  constitute  prolonged  restraint. 
Evidence was provided to you regarding this during the inquest hearing. The guidance currently provided 
to ambulance staff confirms that any form of patient restraint should be kept to a minimum and the form of 
restraint must be justifiable based on the circumstances. Currently ambulance personnel do not receive 
any specific training regarding physical restraint. We are aware that The Association of Ambulance Chief 

 
 
 
 
 
  
 
 
 
 
  
 
 
 
 
 
 Executives (AACE) has recently appointed a national lead in relation to this with the intention that a national 
training standard specific to ambulance personnel will be produced. We have liaised with them regarding 
this as well as exploring the options that could be available for the design of a training package for our 
staff. This project of work is ongoing and we will of course ensure that any training that is delivered in the 
future is compliant with any national standard that is set by AACE. 

In the interim, it is our intention to strengthen the direction we provide to our staff to ensure there is a clear 
understanding of the role they must play when attending to a patient who is subject to restraint by police 
officers or has been restrained prior to our attendance. The guidance will confirm that once in attendance 
ambulance personnel are clinically responsible for the wellbeing of the patient and they must work with 
police officers to ensure that any restraint is subject to continuous review and adjusted where appropriate 
to ensure the wellbeing of the patient whilst they are conveyed to a definitive point of care. This will include 
making enquiries regarding the length of time the patient has been subject to restraint prior to the arrival 
of the ambulance crew. The guidance will also reiterate the risks of placing the patient in a prone position 
whether during conveyance or whilst being treated on scene to ensure as far as possible there is a clear 
understanding of these risks and how to avoid them.  

If required, we would be happy to share these guidance documents with you once they have been finalised 
and signed off by our relevant internal review groups.  

Joint working with TVP 

In relation to the steps that we are taking to enhance our joint working with TVP, the following steps have 
been taken: 

1.  Call centre management  

a.  Our  Head  of  Education  and  Quality  Assurance (Clinical  Co-ordination  Centres)  has  met 
with their equivalent at TVP and shared NHS Digital’s guidance document called ‘Spotlight 
On: Acute Behavioural Disturbance (ABD)’. We understand that TVP intend to use this to 
update the training and guidance they deliver to their staff. 

b.  In addition we have drafted a directive regarding using the phonetic alphabet to pass over 
and receive information from other emergency services. As you know, in this specific case, 
the incorrect information was provided to the Trust by TVP which affected the category of 
ambulance response initially reached. Going forward, whilst the full name of the medical 
condition will always be confirmed, any acronyms will be handed over phonetically as well 
to minimise the risk of information being lost in translation. 

c.  We are also working with TVP to ensure that their officers are aware that our call takers will 
attempt to contact them at the scene so that a more accurate triage can be undertaken. 
Whilst it is recognised it may not always be possible for a police officers to answer their 
telephone, it is important that police officers understand the process that will be followed so 
that the appropriate category of ambulance response can be arranged for the patient.  

2.  Operational staff 

a.  It has been agreed and accepted by both TVP and SCAS that regrettably due to operational 
demands, joint face to face training is not currently feasible. This will however be kept under 
review. 

b.  The intention moving forward is for each organisation to regularly share guidance and policy 

documents to promote joint understanding and cohesive working.  

I hope that this letter has adequately addressed the concerns that you have raised. Should you wish to 
discuss these matters further, please contact 
, Head of Legal Services at SCAS who 
will be able to facilitate this. 

 
 
 
 
 
 
 
 
 
 
 
 
 Yours sincerely, 

Chief Executive

Chief Constable  
Thames Valley Police   
Thames Valley Police Headquarters 
Oxford Road 
Kidlington 
OX5 2NX 

Date :   09/02/2023 

Mrs Heidi J. Connor, 
Senior Coroner  
Berkshire 

Re: Inquest into the Death of Mr Neil Saunders 
Response to Regulation 28 Report/Prevention of Future Deaths 

Dear Mrs Connor, 

Thank you for your report sent by letter dated 15th December 2022 under paragraph 
7, Schedule 5, of the Coroners and Justice Act 2009 and Regulations 28 and 29 of 
the  Coroners  (Investigations)  Regulations  2013 
in  respect  of  circumstances 
surrounding the untimely death of Mr Neil Saunders.  

Your report contains the following matters of concern: 

The key concerns around training can be summarised as follows:- 

1.

How long is “prolonged” restraint?

One  of  the  witnesses  questioned  whether  the  guidelines  applied  at  all  if
2.
somebody is under arrest, particularly regarding “contain rather than restrain”. Given
that these are police guidelines, it seems to me likely that they would apply, whether
a  person  is  arrested  for  public  order  offences  or  other  matters  (but  that  should  be
clarified).

3.
The College of Policing slides regarding ABD state that a “Cat 1 call” should
be  made  to  the  ambulance  service.  The  slides  go  on  to  say  that  the  ambulance
service  should  respond  to  ABD  as  a  “category  1”  [response].  It  is  clear  that
categorisation  would  be  a  matter  for  the  ambulance  service  rather  than  the  police,
and  this  training  may  result  it  inappropriate  expectations  on  behalf  of  officers  at
scene,  who  are  expecting  an  ambulance  to  arrive  more  quickly  that  it  in  fact  does.
This in turn could affect their decision-making.

4.
The guidelines also refer to providing “chemical sedation”. This appears to me
to indicate an incorrect understanding of what is likely to be done medically by a first
responding paramedic or emergency care assistant.

1 

 
 It was interesting to note that the parts of the training the officers did seem to 
5. 
remember  were  around  when  the  training  was  provided  in  a  very  physical  way 
(around positions for restraint etc.) and the final slide “ABD = A&E”. It appears that 
the  more  “classroom  based”  training  is  less  well  received.  I  understand  that  the 
College  of  Policing  is  changing  its  methods,  and  it  may  be  that  an  educational 
consultant with policing background could assist with this in trying to achieve training 
that will stick with those being trained more effectively. 

Is there a better way for the College of Policing to ensure that the training has 

6. 
worked and is embedded? 

Training generally 

I raise 2 points here: 

1. 

2. 

Checking of guidance which is infrequently used 

Joint training with ambulance services 

Response to the Regulation 28 concerns 

On  receipt  of  your  letter,  Thames  Valley  Police  (“TVP”)  convened  a  group,  chaired 
by  Chief  Superintendent 
,  to  address  your  concerns.    This  group 
comprised  of  senior  representatives  from  the  College  of  Policing  (CoP);  South 
Central  Ambulance  Service  NHS  Foundation  Trust  (SCAS);  Association  of 
Ambulance  Chief  Executives  (AACE)/  National  Ambulance  Services  Medical 
Directors  (NASMeD)/JRCALC);  and  TVP’s  Medical  Director 
, 
Consultant in Emergency Medicine and Pre-Hospital Care. 

Our response to the specific matters of concern set out in your notice are detailed  
below.  

1.  How long is “prolonged” restraint? 

•  The College of Policing have advised that there is no set definition for ‘prolonged 
, the teaching outlined below 
restraint’. As a result, and on the advice of 
will be based on the assumption that within individuals, the physiological changes 
that can take place during restraint are dynamic, in that they are different for each 
person and in each situation. The teaching will reinforce Officer’s staying alert to 
the needs of the subject at all times. 

2.  Clarification of ‘contain rather than restrain’ 

•  At any incident, Officers will have a range of tactical options available to them in 
terms  of  the  subject  management.  Using  the  National  Decision  Model  (NDM), 
Officers  will  decide  on  what  tactic(s)  may  be  necessary,  justified,  proportionate 
and  legitimate.  The  decision  to  contain  rather  than  restrain  is  for  the  Officer  to 
consider,  and  applies  whether  the  subject  is  under  arrest  or  not.  The  Training 

2 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 material on  this issue has  been  updated to ensure that  Officers understand this 
point.   

3.  Police expectation of a ‘Category 1’ response by Ambulance Service 

•  Guidance  received  from  SCAS  and  the  AACE  has  clarified  the  nationally 
mandated  list  of  Category  1  call  ‘types’  and  the  descriptions.  The  AACE  have 
confirmed that ABD would be classified as a Category 2 incident. This will only be 
upgraded  to  a  Category  1  if  the  clinical  picture  dictates  it.  As  a  result,  TVP’s 
teaching  materials  have  been  changed  to  place  greater  emphasis  on  the  signs 
and symptoms of ABD and the physical effects of restraint.  

•  On  contacting  Ambulance  Services,  Police  Officers,  Special  Constables,  Police 
Community  Support  Officers,  and  Detention  Officers  will  be  taught  to  be  as 
accurate as possible in describing a subject’s history (appropriate for the level of 
an Emergency First Aider), signs and symptoms, and the importance of providing 
updates to any changes in condition. 

•  The  original  references  to  ABD  being  classified  as  a  ‘Cat  1’  Ambulance 
Response  and  the  use  of  ‘chemical  sedation’  which  was  included  in  the  CoP’s 
ABD  E-Learning  package,  have  been  removed  by  TVP  and  training  materials 
updated in accordance with the guidance from SCAS and the AACE. As such, it 
will still be taught that ABD is considered a medical emergency. 

4.  Guidance referring to ‘chemical sedation’ 

•  Please see response above. 

5.  Classroom based verses physical training scenarios 

•  TVP’s response includes new learning materials and programmes for all frontline 
Officers  and  Staff  who  have  direct  contact  with  the  public.  This  learning  will  be 
blended learning which will include classroom-based inputs, supported by written 
material  and  subject  to  practical  assessments,  which  will  include  a  physical 
scenario to consolidate learning as set out below.   

•  Police  Officers,  PCSOs,  Special  Constables  and  Detention  Officers  (as  defined 
above),  are  required  to  achieve  re-accreditation  in  Public  and  Personal  Safety 
Training (PPST) and First Aid  Training annually, as mandated by the College of 
Policing. 

Public and Personal Safety Training: 

• 

In April 2023, the College of Policing are introducing a new PPST 2-day training 
and  assessment  re-accreditation  programme  for  all  Forces  nationally.  The  new 
programme  will  be  based  around  six  scenarios  to  aid  officer’s  learning  and  the 
retention  of  knowledge  and  skills.  Forces  have  until  the  end  of  March  2024  to 
introduce the new programme, which is due to go live in TVP on 14th November 
2023. 

3 

 
 
 
 
 
 
 
 
 
 
 
 
 
 •  Before  the  introduction  of  the  new  CoP  PPST  programme,  TVP  will  be  re-
accrediting Officers and Staff who require re-accreditation prior to November with 
an  updated  training  package.  Delivery  of  the  new  1-day  package  (called  PST 
Mod 1) will start on 2nd March 2023 through to November 2023.  

•  PST Mod 1 training will start with an operational update presentation, designed to 
cover the organisation learning from the Neal Saunder’s Inquest, ABD and issues 
related to Prone Restraint. Officer’s will receive refresher training on what ABD is; 
it’s  physical  signs  and  physiological  symptoms;  how  it  should  be  treated  as  a 
medical emergency; and how Officer’s should call for an Ambulance and update 
the  Police  Control  Room.  Officer’s  will  also  be  refreshed  in  the  application  of 
Prone  Restraint  and  the  safety  considerations  around  signs  and  symptoms  of 
positional  asphyxiation,  and  the  use  of  the  National  Decision  Model  (NDM)  and 
the  principles  behind  the  use  of  a  Safety  Officer  to  act  as  an  advocate  for  the 
subject. 

•  Learning  related  to  the  Operational  Update  Presentation  will  then  be  reinforced 
and assessed within the practical elements of the training day, this includes a 4-
stage  layered  scenario.  The  scenario  is  designed  to  escalate  through  from  a 
compliant  subject  (at  Stage  1),  to  a  non-compliant  subject  who  becomes 
unresponsive during control, requiring the officers to recognise this and take the 
appropriate  action  (at  Stage  4).  Training  will  include  an  assessment  of  Officer’s 
understanding  of 
implications; 
consideration  of  ‘contain  rather  than  restrain  (if  safe  to  do  so)’;  communication 
processes, de-escalation, and the escalation of the medical emergency.  

impact  of  physical  restraint;  medical 

the 

•  Following  the  scenario,  each  Officer  will  complete  the  Mod  1  2023  written  test 
which consists of 10 questions covering the knowledge areas of ABD and Prone 
Restraint.  Those  officers  that  do  not  achieve  100%  will  be  notified,  along  with 
their  Supervisor  and  the  appropriate  development  learning  will  be  sent  in  an  e-
mail with the appropriate presentation for the Officer to review. 

•  The Training Resources relating to the training described above can be provided 

at your request, should you wish to view them. These include:- 

  PST  Mod  1  Lesson  Plan  2023  –  This  document  summarises  the 
content that sets out the aims, objectives and timetable for the training 
  PST Mod 1 Op Update Presentation 2023 – PowerPoint presentation 
that  addresses  Service  Improvement  Requirement  (Reg.  28),  What  is 
ABD,  How  it  presents,  What  do  we  do,  Prone  restraint,  National 
Decision making Model (NDM) and NDM Subject perspective. 

  PST Mod 1 Operational Update Trainer Notes 2023 – Trainer notes 
are documents that trainers use as reference and provide the detail of 
the content to be delivered by the training team to ensure consistency. 

  PST Mod 1 Layered Scenario 2023 – Trainer Notes 
  PST Mod 1 Positional asphyxia Drill 2023 – Trainer Notes 
  PST Mod 1 2 Officer Control 
  PST Mod 1 Written Test 

•  The relevant sections of TVP’s PST MOD 1 training material have been reviewed 

by the CoP and feedback incorporated.  
4 

 
 
 
 
 
 
 First Aid Training: 

•  To  reinforce  the  organisational  learning  further,  TVP  will  also  ensure  that 
additional  training  material  is  included  within  all  First  Aid  and  Medics  training 
programmes from the 1st May 2023. This will ensure that Officers and Staff who 
have direct contact with the public will receive key aspects of this learning within 
both  their  mandatory  training  inputs  (PPST  and  First  Aid  re-accreditation,  i.e. 
twice in any year).  

•  The  material  added  into  First  Aid  training  will  include  an  expansion  of  the  CoP 
material  on  Acute  Behavioural  Disorder  (ABD),  written  in  conjunction  with  the 
guidance received from SCAS and AACE to ensure consistency. This will include 
signs  and  symptoms  related  to  ABD,  and  the  physiological  effects  of  restraint; 
guidance  on  information  to  Ambulance  Control  and  why  ABD  is  a  medical 
emergency.  

•  New  material  added  to  the  E-Learning  element  of  First  Aid  /  Medics  Training 
packages  is  assessed  within  the  practical  skills  assessment  phase  of  courses. 
This  blended  learning  approach  ensures  Officers  and  Staff  have  and  retain 
access  to  the  knowledge  components  of  their  training,  whilst  the  practical  skills 
assessments test that retention and application.  

•  The Training Resources relating to the training described above can be provided 

at your request, should you wish to view them. These include:- 

  First Aid Training – additions to E-Learning 2023 
  HSD1C  First  Aid Trainer  Notes  2023  –  reference  notes  and  content 

detail for the training team to ensure consistency. 

Initial  Training  (Police  Officer,  Police  Community  Support  Officer,  Special 
Constable, Detention Officer): 

• 

Initial training programmes for all Police Officers and Staff in Public and Personal 
Safety Training and First Aid, are being updated to include new material on ABD 
and  restraint,  and  a  written  test  included  to  check  knowledge.  As  with 
reaccreditation  training,  practical  skills  assessments  will  further  check  that  the 
knowledge components have been retained, and skills applied correctly. 

•  The training resources relating to the training described above can be provided at 

your request, should you wish to view them. These include:- 

  Foundation ABD PowerPoint– Amended and will be delivered until 

the new the CoP ABD guidelines and package is available. 

  Foundation ABD Trainer notes – Updated to include learning and 

good practice identified. 

  Foundation written Test - updated to include questions on ABD.  

Contact Management Training 

•  Training specifically focused on Control Room and Contact Centre staff will begin 
in  May  2023.  This  will  raise  awareness  around  Acute  Behavioural  Disorder,  its 

5 

 
 
 
 
 
 
 
 
 
 
 signs  and  symptoms;  what  to  do  if  officers  are  at  scene  with  a  suspected  ABD 
patient  and  why  this  is  a  medical  emergency.  The  training  will  also  raise 
awareness that when dealing with ABD, the importance of using the full name of 
the medical condition and not using acronyms, especially when passing details to 
SCAS. In the interim, all staff will be briefed on this specific point.  The briefings 
will  be  conducted  by  an  Inspector/Operational  Duty  Manager  at  their  place  of 
work  and  all  staff  receiving  this  briefing  will  sign  to  say  they  have  understood 
what is expected of them.  

• 

It  is  worth  noting  that  last  year,  2022,  the  Contact  Management  PCR,  Contact 
Management  Centre  and  Front  Counter  Staff  all  received  bespoke  NDM  THOR 
(Threat  Harm  Opportunity  and  Risk)  training  delivered  by  the  departments’  key 
decision makers, Force Incident Inspectors and Operational Duty Managers. This 
training  was  designed  to  support  and  equip  our  staff  making  better-informed 
decisions when managing open incidents and receiving calls from the public.  

•  There  is  no  written  protocol around  how  a  medical  emergency  is  relayed  to  the 
Ambulance Service from Police. It is decision, based on circumstance as to who 
is best to pass the most accurate and timely information. The training will include 
the  following  -  if  the  officer  at  the  scene  suspects  ABD,  then  the  Control  Room 
Operator will state to the ambulance call taker that ‘acute behavioural disorder’ is 
suspected,  and  fully  document  this  in  the  incident  log.  The  Control  Room 
Operator  will  inform  the  officer  on  scene  that  the  Ambulance  Service  will  be 
ringing  their  mobile  phone,  for  greater  detail  of  the  patient’s  symptoms  and 
situational awareness. If circumstances allow, best practice will be that the officer 
on scene rings 999 and speaks directly to the Ambulance Service. This will be an 
auditable  interaction  via  the  Ambulance  Control  Rooms  recorded  lines  and  the 
officer will have initiated their Body Worn Video. 

•  Due  to  the  dynamic  nature  of  ABD  and  associated  medical  conditions,  it  is 
extremely difficult for Control Room Operators to assess if, or when to proactively 
remind officers of guidance in this area. The College of Policing does not provide 
a  definition  of  prolonged  restraint  and  several  factors  such  as  age,  health, 
substance  misuse  and  fitness  may  not  be  apparent  to  Control  Room  staff. 
Planned training will address this issue.  By using the National Decision Making 
Model and  inputs  on  THOR,  Control  Room staff  will  be  encouraged to use  their 
professional  curiosity  and  proactively  interject  reminders  to  officers  on  scene 
relating to ABD and Prone Restraint ‘SNAP Guidance’ products. In a similar way, 
Control  Room  staff  sometimes  remind  officers  around  Body  Worn  Video  use, 
Personal Protective Equipment and Stay Safe advice. 

6.  Assessing and embedding training 

•  Measures  taken  to  assess  knowledge  and  skills  and  reinforce  learning  and 

retention are set out in the answers above. 

•  However,  because  any  annual  recertification  programme  will  take  time  to  reach 
all front line Officers and staff, TVP will issue an operational briefing by the end of 
February 2023, to highlight the key organisational learning and draw attention to 
the new SNAP Guides on ABD and Prone Restraint. 

6 

 
 
 
 
 
 
 
 
 7.  Checking of guidance which is infrequently used 

• 

In  response  to  the  Reg.  28  section  which  states  ‘I  consider  that  police  officers 
should be mandated to review guidance (whether APP guidance or otherwise) in 
any scenario that they have not (or not recently) dealt with’, we have considered 
whether  it  would  be  practicable  to  mandate  officers  to  periodically  review  what 
amounts  to  282  SNAP  Guides,  222  Operational  Guidance  notes,  and  APP 
covering a 24  areas. Given  the  high  volume  of  this guidance,  this  has  not been 
deemed practicable. 

•  TVP  have  mechanisms  to  communicate  guidance  e.g.  through  LPA  operational 
briefings, and where risk is identified we already mandate completion of training 
or viewing of operational guidance.  

•  The  Governance  and  Service  Improvement  Unit  have  designed  a  number  of 
condensed versions of operational guides, known as ‘SNAP Guides’ to act as Aid 
Memoirs  or  Field  Guides  for  operational  Officers  and  Staff.  These  are  available 
on  operational  mobile  phones,  and  a  number  of  communication  initiatives  to 
publicise the SNAP Guides, including visits to LPAs have taken place.  

•  Two new SNAP Guides to cover ABD and Prone Restraint are being designed (to 
be  compliant  with  feedback  received  from  the  CoP)  and  will  be  available  and 
disseminated by the end of February 2023. 

• 

In  addition,  within  PPST  training,  which  includes  the  National  Decision  Making 
Model  (NDM),  specific  guidance  on  how  to  apply  the  NDM  to  manage 
vulnerability, has been included. 

8.  Joint training with ambulance services 

•  TVP  has  been  in  contact  with  SCAS  regarding  the  feasibility  of  joint  training.  It 
has been jointly agreed that logistically this would be difficult to achieve with the 
current  recruitment  and  operational  demand  volumes.  However,  the  benefits  of 
greater sharing of guidance documents was evident and there is a clear appetite 
from TVP and SCAS for this to continue.  The mechanism for this will be via the 
Clinical  Governance  Board  chaired  by  the  Assistant  Chief  Constable  for  Joint 
Operations and Contact Management.                              

I hope the actions taken by TVP go towards satisfying the concerns you have raised 
with regard to the sad circumstances around Mr Saunders death, but please do not 
hesitate to contact if you have anything further for us to consider in this regard.  

Yours Sincerely 

7 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Chief Constable Thames Valley Police  

8