- Understand your legal obligations to report acts of terrorism.
- Follow your organisation's safeguarding policy and procedures if you suspect a vulnerable patient is at risk of abuse or exploitation.
- Raise concerns if you believe a colleague poses a risk to themselves or others.
Terrorist acts – doctors' legal responsibilities
Under the Terrorism Act 2000, it is a criminal offence not to tell the police 'as soon as is reasonably practicable' if you become aware of information which you know or believe 'might be of material assistance' in:
- preventing an act of terrorism
- securing the arrest, prosecution or conviction of someone involved in 'the commission, preparation or instigation of an act of terrorism'.
Conviction could result in a fine or up to five years in prison.
The GMC's Confidentiality guidance states: 'There are a large number of laws that require disclosure of patient information', among these 'prevention of terrorism. You must disclose information if it is required by law.' If you are satisfied that disclosure is legally required, you should promptly disclose relevant information to the police.
Ordinarily, the GMC expects you to tell patients about legal disclosures. However, in cases of suspected terrorism, you would probably be justified in not informing the patient as this would undermine the purpose of the disclosure.
Healthcare and the government's anti-radicalisation strategy
The healthcare sector is a 'critical partner' in the government's Prevent strategy, which aims to stop people being drawn into terrorism.
Prevent guidance for healthcare organisations says: 'There are many opportunities for healthcare staff to help to protect people from radicalisation – the key challenge is to ensure that healthcare workers are confident and knowledgeable in addressing situations that cause concern.'
Healthcare professionals are not required to take on surveillance or enforcement roles as a result of Prevent. Instead, organisations are expected to 'work with partner organisations to contribute to the prevention of terrorism by safeguarding and protecting vulnerable individuals and making safety a shared endeavour'. The government says this approach is 'no different from safeguarding vulnerable individuals from other forms of exploitation'.
Raising concerns and sharing information
Every patient has a right to confidentiality, but you may disclose information in order to protect individuals or the wider public from serious harm. If you are concerned that a patient is being radicalised or exploited, you should:
- Reflect on the factors that make the person vulnerable to abuse or exploitation and what aspects of their behaviour give you cause for concern. The Prevent guidance includes possible warning signs and says healthcare workers should use their judgement in determining the significance of any unusual changes in behaviour.
- Consider whether raising concerns is a proportionate response, given the ongoing risk to the individual and others. Balance this against the possible harm and distress to the patient of sharing information about them, for example the implications for their future engagement with the treatment. However, it will generally be appropriate to disclose information if a vulnerable person is at risk of abuse; a patient has confessed to a serious crime, or they pose a risk to the public.
- Seek advice from your manager or your organisation's Prevent lead if you are unsure whether your concerns are reasonable.
- If you decide to disclose information, the GMC says you should 'tell patients about such disclosures whenever practicable, unless it would undermine the purpose of the disclosure to do so'. The NHS Confidentiality Code of Practice says: 'Wherever possible the issue of disclosure should be discussed with the individual concerned and consent sought. Where this is not forthcoming, the individual should be told of any decision to disclose against his/her wishes.'
- Record the steps you took to discuss the issue with the patient and your justifications for disclosing information without their consent.
- Follow your organisation's Prevent policies and procedures when raising concerns and share relevant information promptly with the appropriate person. It may be necessary to share safeguarding information with other organisations, such as social services, to ensure the patient receives appropriate support.
- Seek advice from your manager or the MDU if you are unsure how to proceed.
Reporting concerns about a colleague
There are also rare examples of healthcare professionals becoming radicalised. If you have concerns about a colleague:
- As with patients, reflect on the aspects of the colleague's behaviour that give you cause for concern, with reference to the government's Prevent guidance.
- The GMC says you have a duty to raise concerns if you believe 'patient safety or care is being compromised by the practice of colleagues...' This duty overrides any personal or professional loyalties.
- So long as your concern is honestly held, you do not need proof. Don't be tempted to turn detective to find evidence to back your suspicions, as this is likely to backfire and could lead to unnecessary delay.
- Follow your organisation's procedures for raising concerns about staff members. This will usually involve raising concerns with your manager or the local Prevent lead. The Prevent guidance for healthcare organisations includes a model process for raising concerns in this situation.
- Keep a record of your concerns and the steps you have taken to resolve them.
- Expect to be updated, although your colleague's confidentiality should still be respected. If you are concerned that nothing has been done and your colleague remains a serious risk, you may need to escalate your concerns, but you should seek MDU advice first.
This guidance was correct at publication 30/03/2018. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.