A top forensic physician has criticised the quality of medico-legal help available to some police station detainees, backing lawyers’ claims that cost-cutting in medical care could block access to justice.

Dr Jason Payne-James, vice-president at the Faculty of Forensic and Legal Medicine, Royal College of Physicians, said: ‘The standard of medical help for detainees has become a postcode lottery, with certain police forces saving money by using nurses or paramedics instead of doctors. But this is a specialist area requiring combined medical, forensic and legal knowledge, with people’s freedom and welfare at stake.’

Dr Payne-James called for a review of healthcare provision in police stations to identify best practice across all forces.

Rodney Warren, director of the Criminal Law Solicitors Association, said the Police & Criminal Evidence Act requires an appropriate person with appropriate medical skills to examine detainees. ‘But nurses and paramedics do not have "appropriate" skills, particularly where diagnosis is complicated by detainees showing a mix of physical and mental health problems. Detainees, wrongly judged fit for questioning, could incriminate themselves or confess to a crime they had not committed.’

A particular worry, according to London forensic medical examiner Dr Peter Green, is that nurses and paramedics are often directly employed by the police, creating possible conflicts of interest.

Richard Charlton, chairman of the Mental Health Lawyers Association, agreed the use of under-trained personnel could cause miscarriages of justice. ‘I’ve even seen a confession recorded in the client’s medical notes.’

The Association of Chief Police Officers said that officers carry out ‘as a priority’ risk assessments on everyone coming into police custody to decide whether medical help is needed.