It appears since Prevent became a statutory duty on those working in the health sector since July 2015 the NHS referred 420 patients and staff to police in England and Wales in a year over concerns they were at risk of radicalisation, which equates to an average of 35 referrals a month.
But as a doctor I have questions.
I have spent years ensuring my consulting room is a safe space for patients to talk confidentially about their problems with the reassurance given that confidentiality will only be broken as per GMC guidance but can I still give that assurance when with Prevent the threshold for breaking confidentiality seems lower?
It's frustrating as a doctor to think my patients may not fully disclose information to me because I am expected to make complex nuanced judgments as to whether patients buy into British values, and my ability to question freely is now hindered because of a fear of 'mistrust' by the patient. This lack of information offered by the patient may also mean they aren't accessing the treatment that may be right for them.
For me as a doctor safeguarding has always prioritised the welfare of the patient at issue whereas with Prevent the priority doesn't appear to be the patient, but is about protecting the state from violent and non -violent extremism, this precedence is especially worrying where the patient concerned is a child.
Nine out of ten referrals to Prevent from the NHS are found to have no risk of radicalisation after assessment. Surely there is something significantly wrong with the program for such a large proportion of referrals to be deemed as needing no further action compared to an average of 37% within safeguarding? What happens to these patients when they have been through the stigmatisation of a prevent referral? How long is data stored on these individuals and where? There appears to be no support, monitoring or follow up for these patients, many of whom are referred without their knowledge or consent. Surely the lasting trauma these patients experience, especially children, goes against safeguarding's primary consideration of serving the best interests of the child?
I clearly understand the definition of safeguarding when it comes to child neglect, physical abuse and sexual abuse. In relation to extremism, however, there appears to be no shared consensus or definition as to what children should be safeguarded from but despite this Prevent is part of mandatory safeguarding training within which I am given 2 hours training to spot those vulnerable of radicalisation based on vague criteria when there are police officers who struggle after years to do the same.
Throughout my career I'm taught to practice evidence based medicine and question and reflect on my work. Where is the evidence that states there is a link between non-violent extremism and terrorist acts? Why is evidence which was based on flawed science, trialled on approximately 20 convicted offenders and used to create the screening ERG 22+ tool being applied to the whole population including my patients?
As referrals continue to rise to Prevent how are my colleagues personal biases not impacting on their judgement to refer? Is the threshold to refer lower regardless of the impact of an incorrect referral as doctor are afraid they may be held to account, now that the duty is statutory, if one of their patients commits an act of terrorism? What are the implications of Prevent on doctors who become more religious or hold political views?
All other areas of safeguarding are subject to clinical governance and audit to ensure best practice is occurring. This does not appear to be happening with Prevent. Is this because the duty is being driven down on authorities by security officials rather than practitioners ? Access to data on Prevent referrals is limited and there is no transparency compared to safeguarding. This is not best clinical practice.
Safeguarding already existed and identified vulnerable individuals so why did we need prevent?
These concerns apply to both my Muslim and non - Muslim patients. It isn't just an issue of training. There appear to be flaws inherent in prevent itself not only with respect to welfare of the patient but also to countering terrorism. An increase in far right referrals does not justify or alleviate the concerns.
I have a duty of care to all my patients and their care, dignity and safety is my first concern. I also do not wish to be blown up whilst out shopping at Trafford Centre. This is why I voice my fears about Prevent and this is why I will always refer my patients to safeguarding as I always have done if I have any concerns.