I have been working as a doctor in the NHS for the last ten years. For the most part, my friends in healthcare know that I have been (and continue to be) a significant advocate for what is known as Quality Improvement in Healthcare.
There is a science behind Quality Improvement, a whole thought process which takes the practitioner from identifying a problem to developing what is hopefully a sustainable solution. Following a structured process is vital, otherwise you run the risk of developing a solution which is entirely unsuitable for the problem that you identified at the beginning.
Ill-thought out interventions lack sustainability, credibility and nearly always cause more problems than they are designed to fix.
The question at the heart of any Quality Improvement measure is: what is the problem that you are trying to solve?
When I read about the Counter-Terrorism and Security Bill last year, I became concerned that this would be a bill that will compel other professionals in similar institutions to inform security services if they deem from their assessment that individuals are “radicalised”, “radicalising” others or “at risk of being radicalised”. Now that it has become an Act, it seems my fears were justified.
The problem that the Home Secretary is attempting to solve is to prevent the cultivation of a tiny subset of individuals who may undertake violent actions towards other members of society. A noble aim. Except the way that she intends to achieve this is to develop a state that destroys the very essence of interaction, an element so fundamental to peaceful coexistence that if one did not know better, they may be led to believe that the Home Secretary was intentionally attempting to sabotage relations between Muslims and the rest of society. That element is trust.
The interaction between a healthcare professional and a patient is based entirely on trust. When I am working in the Accident and Emergency department and a patient presents with depression, for example, the only reason they tell me about their most personal of issues is because they trust me. They know that whatever they tell me will not go any further unless they choose to allow it.
Our role as healthcare professionals is to maintain that trust and to treat our patients without prejudice, without caring about their race, their sexuality, or their religion, but rather to treat them as vulnerable human beings who have come seeking a cure or relief from their symptoms. The Counter Terrorism and Security Act strips away the very essence of that relationship.
In Quality Improvement, after identifying the problem, we define an intervention that we feel will solve the problem. One of the ways of measuring the effectiveness of that intervention, is through balancing measures (‘changes designed to improve one part of the system causing new problems in other parts of the system.’). It takes little intelligence to realise that if a group of people are going to be scrutinised by healthcare professionals, their likelihood of presenting with an acute problem to a healthcare setting is significantly reduced.
The consequence of this Act is that individuals who are in need of medical attention will not seek it. Morbidity and mortality among sections of the population is likely to increase.
One may scoff at this assertion and say that only a small subset of people may feel like this and the Act would not affect the majority of Muslim patients, but the radicalisation signifiers government’s Vulnerability Assessment Framework are wholly non-specific enough to include all.
Another concern around the Counter Terrorism and Security Act is time. The Home Secretary would like all healthcare professionals to look for signs of extremism in their patients and to inform the relevant authorities. What exactly does the Home Secretary believe healthcare professionals do all day? Have healthcare professionals not got enough on their desks?
Perhaps the Home Secretary missed the memo that highlights the terrible plight of hospitals in the United Kingdom, with the vast majority of them missing their four-hour target in Accident and Emergency departments. Perhaps she missed the fact that pressures on healthcare professionals are leading to deficiencies in care.
The Act now compels professionals to assess the patient for another reason which has no bearing on their presenting complaint. How exactly are we expected to undertake this assessment?
From the documentation it seems this will be a highly subjective activity; what one healthcare professional may consider extremism will be viewed by another as religious orthodoxy. Take the example of a woman wearing a niqab who insists on being seen by a female healthcare professional. She may well be considered “extremist” by certain nurses and doctors. The same goes for a mother reciting verses from the Holy Qu’ran to calm a child in pain.
This is where the narrative of non-violent extremism being a precursor to violent extremism is dangerous. There is no such thing as non-violent extremism. This is a misguided attempt at conflating religious orthodoxy with the “extremism”.
I can only imagine the ambivalence of my colleagues who I have worked with for so many years at having to implement such draconian, Orwellian ideas. My suspicion is that most of them will treat it for what it is: a ridiculous after-thought from a government which is trying desperately to appease the growing far-right in a bid to remain in power.
A policy which has not been considered in an appropriate fashion, which has little evidence behind it, whose repercussions have not been considered, whose implementation is questionable at best, will inevitably lead to a greater amount of harm than any possible good its architects could have imagined. More than that, it will not adequately answer the problem it seeks to address.
My advice to the Home Secretary would be to attend a course on Quality Improvement. Here she will learn about tools such as driver diagrams, which help the improver to identify the initial problem and look at all the contributory issues to that problem. In the context of extremism, some of these contributory issues include widespread detention-without-trial, torture and imprisonment of Muslims worldwide, and the continued aggressive bombing in the Middle East.
She would have to realise that any intervention needs to meet certain criteria before it is considered valid, and from a Quality Improvement point of view, what she is presenting is woefully inept at solving the central issues.
As a clinician, as a healthcare professional, as a human being who cares for the welfare of other human beings the proposals in this Act are so flawed that the end result can only be the destruction of an institution of which I am so proud to be a part.
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