Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, said in his letter last week: 'Contrary to Dr Payne-James’s view, nurses are well-trained specialists and deliver high-quality care day in, day out'. I have to protest most strongly that Dr Carter ascribes to me views that I simply do not hold and have never expressed.

I have worked in multi-professional settings throughout my professional life and in particular have worked with highly trained, extremely skilled nurses for the last five years in the police custodial setting, within the Metropolitan Police. I am a strong advocate for multi-professional working. I am also a strong advocate for appropriate skills, competencies, training and qualifications.

The point well made in the article is that police custodial healthcare is a postcode lottery. Police services across England and Wales have a wide variety of delivery models using multiple healthcare professionals with different skills and competencies, no standardised training, no agreed or standardised qualifications, sometimes employed by police, self-employed, or employed by commercial providers. Detainees in custody are a vulnerable patient group and have many healthcare needs which cannot necessarily be met appropriately by all nurses, all paramedics, all emergency care practitioners, or all doctors after a two- or three-week training period. Recently published research by myself and colleagues confirms this.

Dr Carter refers to 'many excellent nursing initiatives around the country which include mental healthcare delivery, acute assessment skills, sexual assault care and treatment, together with the development of skilled forensic nurse practitioners', and these indeed embrace a range of skills, which are not available in all police services.

Unfortunately, this piecemeal approach has little or no evidence base. Indeed the evidence base to support these or any aspect of custodial healthcare services is virtually non-existent. I hope that Dr Carter and the RCN will be able to publicly support the view (which I hold) that all professional bodies should be calling for a rigorous, independent, multi-professional review (including lawyers) of police custodial healthcare services to establish a proper, safe and appropriately resourced multi-professional service - instead of introducing untried and untested, potentially costly initiatives which may disadvantage the vulnerable patient population.

Professor Jason Payne-James Director, Forensic Healthcare Services Vice-president (forensic medicine) Faculty of Forensic & Legal Medicine, Royal College of Physicians