Showing posts with label doctors. Show all posts
Showing posts with label doctors. Show all posts

Monday 24 October 2016

"If the community sees [PREVENT] as a problem, then you have a problem”


Image for earlier report by Rights Watch LINK

Earlier this month Brent Council organised a public discussion on Extremism at which the majority of the audience appeared to be opposed to the Prevent Strategy - not because they were in favour of 'Extremism' but because they saw the strategy as sterotyping the Muslim community and being implemented in a top-down way which excluded community organisations. Additionally it threatened free speech in schools and colleges and had a corrosive effect on good community relations.  Overall it was likely to be counter-productive.

Now Open Society has taken up many of these issues in a report entitled Eroding Trust: The UK's PREVENT Counter Extremism Strategy in Health and Education LINK

Concerned organisations in Brent has set up a Monitoring Group on Prevent on Facebook which can be found HERE.

As a contribution to the Brent debate I publish below the Executive Summary of the Open Society Report:
“I’ve never felt not British. And this [Prevent experience] made me feel very, very, like they tried to make me feel like an outsider. We live here. I am born and bred here, not from anywhere else”.
“It could have gone the opposite way if I wasn’t thinking straight, if I were the type who was being brainwashed. The way they went about it, [Prevent] could have made me do exactly what they told me not to do. I associate with Prevent negatively, it is not helpful at all”
 Executive Summary and Recommendations


The UK’s Prevent strategy, which purports to prevent terrorism, creates a serious risk of human rights violations. The programme is flawed in both its design and application, rendering it not only unjust but also counterproductive. 
Launched in 2003, the Prevent strategy has evolved against the background of increased public fears over the threat of “home grown” terrorism. The strategy in its cur- rent form aims “to stop people becoming terrorists or supporting terrorism”. In 2015, legislation created a statutory Prevent duty on schools, universities, and NHS trusts, among other public sector entities, to have “due regard to the need to prevent people from being drawn into terrorism”. This requires doctors, psychologists, and teachers, among other health and education professionals, to identify individuals at risk of being drawn into terrorism (including violent and non-violent “extremism”) for referral to the police-led multi-agency “Channel” programme (for England and Wales) or “Prevent Professional Concerns” (for Scotland), both of which purport to “support” such individuals. 
This report analyses the human rights impact of Prevent in its current form in the education and health sectors. It focuses on these sectors because they are critically dependent on trust and have particular care-giving functions that have not traditionally been directed towards preventing terrorism. Under Prevent, doctors and teachers who have a professional duty to care for their charges are now required to assess and report them for being at risk of “extremism”, which is defined as “vocal or active opposition to fundamental British values, including democracy, the rule of law, individual liberty and mutual respect and tolerance of different faiths and beliefs”. Because the conscription of these sectors into preventing terrorism is part of a growing trend, the report’s principal findings, listed below, not only apply to the United Kingdom, but are relevant and instructive for other governments grappling with these challenges. 
First, the current Prevent strategy suffers from multiple, mutually reinforcing structural flaws, the foreseeable consequence of which is a serious risk of human rights violations. These violations include, most obviously, violations of the right against discrimination, as well the right to freedom of expression, among other rights. Prevent’s structural flaws include the targeting of “pre-criminality”, “non- violent extremism”, and opposition to “British values”. This “intensifies” the government’s reach into “everyday lawful discourse”. Furthermore, Prevent’s targeting of non-violent extremism and “indicators” of risk of being drawn into terrorism lack a scientific basis. Indeed, the claim that non-violent extremism – including “radical” or religious ideology – is the precursor to terrorism has been widely discredited by the British government itself, as well as numerous reputable scholars. Prevent training, much of it based on unreliable indicators, appears to be largely unregulated. Moreover, the statutory duty creates an incentive to over- refer. This incentive is reinforced by the adverse consequences associated with non-compliance with the Prevent duty and the lack of adverse consequences for making erroneous referrals. The case studies and interviews in this report confirm the tendency to over-refer individuals under Prevent. The fundamental nature of these defects makes them unlikely to be cured by a mere renaming of Prevent to “Engage”.

Second, Prevent’s overly broad and vague definition of “non-violent extremism” creates the potential for systemic human rights abuses. On the basis of this definition, schools, universities, and NHS trusts, among other “specified authorities” subject to the Prevent duty, are required to assess the risk of children, students, and patients being drawn into terrorism and report them to the police-led Channel programme where necessary. By the government’s own admission, thou- sands of people have been erroneously referred to the Channel programme. Individuals (including children) erroneously referred under Prevent experience the referral as inherently stigmatising and intensely intimidating. They also fear continued surveillance and the creation and retention of Prevent records, which may taint them and lead others to view them as “extremists” in the future. 
Specifically, the targeting of non-violent extremism raises serious concerns about possible violations of the right to freedom of expression. Children in schools have been targeted under Prevent for expressing political views. University conferences relating to Islamophobia and Islam in Europe have been cancelled, raising questions of possible breaches under the Education Act (1986) and article 10 of the European Convention on Human Rights. More generally, the case studies and interviews in this report suggest that Prevent has created a significant chilling effect on freedom of expression in schools and universities, and undermined trust between teachers and students. This risks driving underground, removed from debate and challenge, conversations about controversial issues such as terrorism. In addition, as indicated by the large number of interviewees for this report who requested anonymity, there is a genuine and intensely held fear among some that public criticism of Prevent will trigger retaliation. This fear is particularly acute for parents who fear that their children will bear the brunt of the retaliation. 
Third, the Prevent duty creates a risk of discrimination, particularly against Muslims. Frontline professionals have broad discretion to act on their conscious or unconscious biases in deciding whom to report under Prevent. Current and former police leads for Prevent recognise that currently, Prevent operates in a cli- mate marked by Islamophobia. Significantly, between July 2015 and July 2016, Islamophobic crime in London rose by 94 percent. This climate creates the risk that Muslims in particular may be erroneously targeted under Prevent. All of the case studies relating to the targeting of individuals under Prevent raise serious questions about whether they would have been targeted in this manner had they not been Muslim. Relatedly, in some case studies, Muslims appear to have been targeted under Prevent for displaying signs of increased religiosity, raising questions about the violation of their right to manifest their religion.
Fourth, by requiring the identification and reporting of individuals at risk of violent and non-violent extremism, Prevent creates a risk of violations of the right to privacy. Many of the case studies describe individuals being intrusively questioned under intimidating conditions about their religious and/or political beliefs. One case study raises troubling questions about the collection (apparently without informed consent) of names and political opinions from Muslim children for the Home Office.

Fifth, there are serious concerns about the treatment of children under Prevent. Although the government describes Prevent as a form of “safeguarding” (a statutory term which denotes promotion of welfare and protection from harm), the two sets of obligations have materially different aims, particularly with respect to children. In contrast to the Prevent strategy, for which the primary objective is preventing terrorism, the primary objective of the duty to safeguard children under domestic legislation is the welfare of the child. This reflects the obligation under article 3(1) of the Convention on the Rights of the Child to make the best interests of the child a primary consideration in all actions relating to children. Accordingly, while compliance with safeguarding obligations would only permit referral to Channel while prioritising the best interests of the child, the Channel duty guidance does not specify that as a mandatory or even a relevant consideration. All of the case studies in this report relating to children – including one in which a four year-old child was targeted– appear to be instances in which the best interests of the child were not a primary consideration. 
Sixth, the Prevent duty risks breaching health bodies’ duty of confidentiality towards their patients and undermining the relationship between health professionals and their patients. The standard for disclosure of confidential information under Prevent appears to be much lower than that warranted by the common law duty of confidentiality enshrined in the NHS confidentiality code of practice and the General Medical Council’s confidentiality guidance. Specifically, requiring a medical professional to report to the police-led Channel programme an individual who is at “risk of being drawn into terrorism”, including “non-violent extremism”, appears to be a much lower standard than requiring the medical professional to report (under the GMC guidance) the individual only when failure to disclose confidential information would expose others to a risk of death or serious harm. This could generate breaches of the confidentiality duty along with violations of the right to private life under article 8 of the European Convention on Human Rights.

Finally, there are serious indications that Prevent is counterproductive. The case studies show that being wrongly targeted under Prevent has led some Muslims to question their place in British society. Other adults wrongfully targeted under Prevent have said that, had they been different, their experience of Prevent could have drawn them towards terrorism, and not away from it. Government data reveal that 80% of all Channel referrals were set aside, implying that there were thousands of individuals wrongly referred to Channel. This in turn risks under- mining the willingness of targeted communities to supply intelligence to law enforcement officials which could be used to prevent terrorist acts.
 
As Sir David Omand, the architect of the original version of Prevent, has observed: “The key issue is, do most people in the community accept [Prevent] as protective of their rights? If the community sees it as a problem, then you have a problem”. This report demonstrates that the UK’s Prevent strategy is indeed a serious problem. 
Recommendations

To the UK Government:

1.     Repeal the Prevent duty with respect to the health and education sectors. 

2.     End the targeting and reporting of “non-violent extremism” under the Prevent strategy. 

3.     End the use of empirically unsupported indicators of vulnerability to being drawn into terrorism. 

4.     Establish an independent public inquiry – with civil society participation – into the Prevent strategy and associated rights violations. 

5.     Create a formal and independent complaints mechanism through which individu- als whose rights have been violated by the Prevent strategy can seek and obtain prompt and meaningful remedies. 

6.     Publicly commit to a policy of zero tolerance regarding retaliation against indi- viduals who allege rights violations under Prevent. 

7.     Publicly disclose data on total number of individuals referred to and processed through Prevent, Channel, and Prevent Professional Concerns (PPC), as well a the breakdown of these figures by age, type of extremism, and referring authority. 

8.     Publicly disclose, to the extent it exists, evidence underpinning and data relating to the UK’s Extremism Risk Guidance (ERG) 22+. 


To the Children’s Commissioners for England, Wales, and Scotland:

Conduct an assessment of the impact of Prevent on children, including but not limited to whether the best interests of the child are a primary consideration in Prevent-related actions. 
To the National Association of Head Teachers, the National Association of Schoolmasters Union of Women Teachers, the Association of Teachers and Lecturers, the National Union of Teachers, and other teachers associations: 
Conduct an assessment of the impact of Prevent on teachers and children, including but not limited to the extent to which the best interests of the child are a primary consideration in Prevent-related actions.

To Universities UK:

Conduct an assessment of the impact of Prevent in universities, including but not limited to its impact on academic freedom and freedom of speech. 
To the General Medical Council: 
Review and clarify professional standards relating to the duty of confidentiality as interpreted and applied in Prevent settings. 
To the British Medical Association, the British Psychological Society,
the Academy of Medical Royal Colleges, the Royal College of General Practitioners, the Royal College of Psychiatrists, and other professional bodies in the health sector: 
Conduct an assessment of the impact of Prevent on the practice of doctors, psychologists and other healthcare professionals, and on patients and patient care, including but not limited to an assessment of how the duty of confidentiality is being interpreted and applied in Prevent settings.

Saturday 30 May 2015

Potential unintended cosequences of a 7 day NHS

Reposted from Open Democracy - Our NHS LINK, author Dr David Wrigley, under Creative Commons terms LINK. No changes have been made from the original text.

“We can become the first country in the world to deliver a truly 7-day NHS”, David Cameron used his ‘first major speech’ of his brand new Conservative majority government to tell us.

It sounds appealing - but does it stand up to scrutiny, or is it just more spin from the former spin doctor?

With 5 years of unconstrained power ahead of him, Cameron will now be expected to deliver on this key Tory manifesto promise.

If Cameron really wants to achieve a 7-day NHS he needs a 7 point plan. 

1. Get the 5 days right first.

If the government wants to make the NHS work safely and efficiently 7 days a week, then it might be a good idea to get the 5 days of Monday-Friday working well beforehand. At the moment the NHS is in dire financial straits – and its demoralised doctors, nurses and other healthcare professionals are leaving or retiring early. What was the adage Cameron likes to use – fix the roof while the sun is shining? Well the sun isn’t shining much in the NHS these days - but you certainly need to fix the roof Mr Cameron, and pretty sharpish. 

2. Invest in your NHS staff 

Nurses got years of 0% or (at best) 1% pay increases during the coalition years. They effectively ‘donated’ over £1.5bn a year of unpaid overtime to keep the NHS afloat amidst the cuts. They were pilloried for failures that were not of their making. Blamed for scandals that were often due to hospitals chasing Foundation Trust status at all costs, their eye only on the bottom line. Many health professionals are becoming unwell now because they cannot give any more to the job they love. The number of nurses off with stress soared by up to 48% last year.

How are they going to feel now the government tells them that in a 24/7 NHS it will be “archaic” to pay supplements for working “unsocial hours”? Many nurses rely on these payments to boost their stagnating income.

3. Get your workforce planning sorted 

Cameron claimed last week that “We are training and hiring many more GPs right now”. But in fact one third of GP training places are empty. And one in three GPs plan to retire in the next 5 years, leading to a workforce time bomb fuelled by 5 years of unpopular NHS policies and huge cuts (known as ‘efficiency savings’).

4. Sort out social care and community healthcare
The huge cuts to local authorities has meant social care being cut to the bone, with budgets being slashed by up to 35%. Many elderly and vulnerable patients are being left alone or with haphazard 10 minute visits from zero-hour contract workers who have to dash from client to client in order to make any sort of living. These patients are becoming increasingly unwell and needing more NHS care. Inadequate community healthcare services (district nurses have been cut by 40% in 5 years) mean they languish in hospital beds, unable to be discharged safely to the community.

5. End the dog eat dog competitive market in the NHS 

We are wasting billions annually on administering an unwanted healthcare market where providers fight each other for contracts and NHS managers spend their lives refereeing and sorting this all out. No one (except the private health industry) has asked for this. The money saved from scrapping this market system could fund decent social care for all the elderly and vulnerable people in our society.

6. Make all NHS services available 7 days a week 

But tell us – as Cameron has so far refused to – what it would cost. Doing it properly would cost billions. As a GP if I see a patient on a Saturday or a Sunday I need the full range of services available to me in order to treat my patients effectively. I need a fully functioning hospital laboratory with blood collection services twice a day over the weekend. I need access to NHS physiotherapy for my patients with urgent musculoskeletal problems. I need access to health visitors to refer children needing their input. I need access to a fully functioning radiology department offering x-rays, CT scans, MRI scans, ultrasound and other investigations. 

7. Beware of the unintended consequences

Increasing the NHS to a full 7 day service will increase demand – and therefore cost. Cameron’s promised ‘extra’ £8bn would merely plug one small gap in the black hole opening up at the centre of the Department of Health. To stretch already overstretched services more thinly will lead to a poorer service in coming years – and no doubt, the electorate to blame the government for a failing NHS. Cameron may have already said he will be leaving Downing Street before 2020, but is this really the legacy he will want to leave for his successor?

A 7 day NHS service is attractive to patients and attractive to politicians seeking votes. But no other western health economy has managed to provide it, as Cameron said himself. With the NHS already struggling many really doubt this government can do it properly. I hope it won’t be imposed on already beleaguered NHS staff and they are forced to provide the 7 day service against their professional advice. 

Be careful of what you wish for Mr Cameron and Mr Hunt. This one could come back and bite you very hard indeed.

Monday 25 August 2014

Grant offered to gather young people's views on health engagement




From Health Watch Brent

Health Watch Brent - Gathering Views Small Grants

Health Watch Brent are awarding grants of up to £200 to local organisations and community groups to help gather views on key areas for health and social care services in Brent. E.g.:
  1. What services young people you engage use (doctors, clinics,family support services etc) 
  2. The perceived quality of such services
  3. How they can be improved
These grants can be used to cover the cost of engaging young people (e.g. via 30 a minute focus group). This could include room hire, printing, or even covering volunteer/staff expenses. 

The objective of Gathering Views is to encourage people to share their views via our Healthwatch survey.  Full details will be outlined soon. Please complete the expression of interest form to apply for this grant: http://goo.gl/Kq20DM 

For further information, please contact membership@healthwatchbrent.co.uk / 07825 215 652