How I wish that politicians would stop telling doctors how to professionally behave.

While we are much vexed about the Health Bill (how can there be a “u-turn” until commissioning is fully stopped?) the Home Office have put out their review of the Prevent counter-terrorism strategy.

I worry  that the authors understand what doctors do, why they do it, and what they can’t do.

From page  83, edited highlights:

The key challenge for the healthcare sector is to ensure that, where there are signs that someone has been or is being drawn into terrorism, the healthcare worker can interpret those signs correctly, is aware of the support which is available and is confident in referring the person for further support. Preventing someone from becoming a terrorist or from supporting terrorism is substantially comparable to safeguarding in other areas, including child abuse or domestic violence…

Given the very high numbers of people who come into contact with health professionals in this country, the sector is a critical partner in Prevent. There are clearly many opportunities for doctors, nurses and other staff to help protect people from radicalisation. The key challenge is to ensure that healthcare workers can identify the signs that someone is vulnerable to radicalisation, interpret those signs correctly and access the relevant support. ..

The Department of Health will need to ensure that the crucial relationship of trust and confidence between patient and clinician is balanced with the clinician’s professional duty of care and their responsibility to protect wider public safety. Where a healthcare worker – be that a speech therapist, community psychiatric nurse or general practitioner – encounters someone who may be in the process of being radicalised towards terrorism, it is critical that the individual is offered the appropriate support. We believe that clear guidelines are needed for all healthcare managers and healthcare workers to ensure that cases of radicalisation whether among staff or patients are given the attention and care they deserve.”

Well, there are an awful lot of people without mental illness and learning disability who are terrorists: the vast majority of people who have a mental illness will not be vulnerable to becoming a terrorist. I’d like to see their association/causation statistics: care must be taken not to infer that people with mental illness or learning disability are somehow high risk for terrorism. Given that the NHS is such a large employer, it would be extraordinary if no one that worked in it had a connection with or conviction for terrorism.

But let us move on to the soft spoken new role for us NHS staff as a ‘critical partner in Prevent’. I have, apparently, to identify the signs of vulnerability in my patient  to terrorism (and this evidence based risk assessment would be what exactly?) and then ‘access the relevant support’.

Medical ethics are quite clear, indeed, if you suspect that a child is being abused, you must act. The situation is slightly different in cases of domestic abuse. If a woman has been domestically abused, and she is competent to make her own decisions, I have no right to break her confidentiality and tell social services. I can try to persuade her, support her, offer her refuge or concel: unless there is, for example, a child in the home that I have concerns about, I have to respect her right.

The GMC are clear on this;

“Disclosure of personal information about a patient without consent may be justified in the public interest if failure to disclose may expose others to a risk of death or serious harm. You should still seek the patient’s consent to disclosure if practicable and consider any reasons given for refusal.  Such a situation might arise, for example, when a disclosure would be likely to assist in the prevention, detection or prosecution of serious crime.”

Yet the Protect review infers that healthcare professionals should be offering “support” to all patients we suspect are being radicalised. Is the ‘suspicion’ of being radicalised a serious crime which is so “critical” we should break confidentiality for?

Same report, page 8

“Radicalisation is usually a process not an event. During that process it is possible to intervene to prevent vulnerable people being drawn into terrorist-related activity. There are some analogies between this work and other forms of crime prevention. Programmes of this kind, although central to an effective Prevent programme, are comparatively new and evidence of impact is correspondingly limited. Allegations have been made that the programmes have been disproportionate and intrusive and have restricted free speech. We recognise the risk that the criteria for entry to these programmes can be too broad. We have considered further allegations that the programmes have been used for spying. ”

So they’d like us to identify people ‘at risk’ or ‘vulnerable’ to radicalisation, refer patients to them for ‘support’ which they’ve said there isn’t evidence for, and inferred that we should break confidentiality to do so?

Doctors and nurses are primarily doctors and nurses. If they find out, during the course of their normal professional activities, something which suggests that their is a wider public risk or a risk to a person unable to act competently for themselves, they have a duty to act. I am not a policeman or counter terrorism agent.  This risks invoking mistrust between professionals and patients: and creating the illusion that healthcare has the ability to spot and solve terrorism is simply wrong.