Doctors and nurses are being advised to breach patient confidentiality and report suspicious people to the state to comply with new counter-terrorism legislation, The Ferret can reveal.
The new guidance for Scotland’s health boards was issued by the Scottish Government and is called Playing Our Part: Implementing the Prevent Strategy.
PREVENT is part of the UK Government’s counter-terrorism strategy called CONTEST, which is led by the Home Office and supported by the Scottish Government.
Under the Counter Terrorism and Security Act 2015, NHS Scotland has a statutory obligation to implement PREVENT and its 164,000 employees are being advised to take pre-emptive action and identify patients who are “at risk of being drawn into involvement in violent extremism and terrorism, before they become involved in actual criminal actions or plans.”
But a civil liberty group has expressed concern at Playing Our Part, describing the official guidance as “Orwellian” and “very disturbing reading” while arguing it could destroy trust between the public and medical staff.
In section 6 of Playing Our Part, the Scottish Government details on page 25 what NHS staff should do if they suspect a patient “is being, or has been drawn into terrorism”.
Regarding patient confidentiality, the guidance states that medical staff can report a patient to the authorities “without their consent” .
This could mean that someone’s personal information is passed to a number of unnamed people involved in a multi-agency process called Prevent Professional Concerns (PPC).
PPC agencies listed in Playing Our Part include Police Scotland, the Scottish Prison Service and social work and education departments at local authorities. MI5, Britain’s internal security service, would also be advised of any security risk.
Section 6.20 of Playing Our Part states: “As PREVENT is based on the active engagement of the individual and is at a pre-criminal stage, under normal circumstances, appropriate consent should be obtained from the individual who is the subject of concern, prior to a referral being made to the Prevent Professional Concerns (PPC).”
This is to comply with Codes of Practice on Confidentiality and Data Protection but section 6.21 of Playing Our Part adds: “However, in exceptional circumstances, where seeking consent prior to referral would cause immediate significant harm to the vulnerable individual and/or where the vulnerable person lacks the capacity to give consent, a referral may be made without consent in their best interests.”
NHS staff have also been told to monitor internal internet use and “to be aware of anyone making frequent visits to websites showing images such as armed conflicts around the world, providing transcripts of speeches and access to material from those involved in radicalisation.”
Any suspicious online activity must be reported to Crime Stoppers, the guidance says, which means that NHS staff are, in effect, being asked to spy on one another.
Employees are also advised to report any patients who express opinions including “the rejection of the principle of the rule of law and authority of the elected government of this country.”
Elsewhere in the guidance, on page 13, NHS staff are advised that the “media” could be a factor in radicalising people, with journalists categorised in a diagram alongside “propaganda” and “extremist/terrorist ideology”.
Richard Haley, of Scotland Against Criminalising Communities (SACC), was highly critical of Playing Our Part. He said: “The PREVENT guidance for health boards makes very disturbing reading. PREVENT’s political and security agenda is not what people expect to encounter at the healthcare frontline.”
“It will create huge difficulties for the effective delivery of healthcare across Scotland. Healthcare requires trust; PREVENT destroys it.”
Haley went on to say that the spotlight will fall mainly on Muslims, adding: “The guidance alerts NHS staff to people who are said to be in danger of being radicalised by the ‘very nature of the health issues they face, or their circumstances’. That may mean that Muslims who visit their doctor, or a casualty department, with injuries from outdoor or sporting activities, will be treated as suspected attendees at a terrorist training camp, especially if they also show an interest in current affairs and some scepticism over the UK’s foreign policy.”
However, a Scottish Government spokesman defended Playing Our Part and said: “The guidance helps health boards to understand radicalisation and to take appropriate steps, along with partner agencies, to prevent individuals from being radicalised and becoming a danger to themselves and others.”
“The guidance was developed following wide-ranging consultation with a range of interested parties from across NHS Scotland and following experience gained from PREVENT pilot projects. The guidance clearly highlights that appropriate consent should be obtained when sharing information about a PREVENT-related concern, and that all appropriate legislation and guidance should be followed,” he added.
“It is equally clear that only in the exceptional circumstances of preventing harm, or a terrorist act being committed, can information be shared without consent. One section highlights various factors and external influences which may make vulnerable individuals susceptible to radicalisation.”
“As the guidance notes, none of these are conclusive in themselves, or exclusive of each other. This information, and the diagram in the document, have been used across the UK and are a recognised representation of potential factors that may influence people who are being radicalised.”
Norman Provan, associate director with the Royal College of Nursing, said: “The medical-legal framework under which nurses, doctors and other health care staff would, under exceptional circumstances, be able to pass on confidential patient information is already well established.”
“For example, the Nursing and Midwifery Council Code states that registered nurses and midwives should share necessary information only when the interests of patient safety and public protection override the need for confidentiality. We would also expect the employers to have a clear policy on handling requests for confidential information and the RCN would support any member with concerns over such a request.”
A spokesperson for the British Medical Association Scotland said: “All doctors are required to comply with General Medical Council guidelines on patient confidentiality that set out the limited circumstances in which it can be breached. Decisions to do this are always made on a case by case basis – the doctor involved needs to carefully balance their patient’s trust against the wider public risk of not talking to external bodies such as the police.”
