Preventing Serious Harm – Time for a National Whistleblower Centre

In 2011, I was asked on behalf of the Home Office to interview anti-radicalisation experts for the relaunch of the Prevent training programme for professionals to ‘ensure vulnerable individuals receive proportionate support at the earliest stages of radicalisation.’ I was asked as a doctor with a long history of supporting NHS whistleblowers, who simply believes we all have a duty to raise concerns about serious wrongdoing in any situation, and that authorities have an equally binding duty to listen, investigate swiftly and fairly, and protect those who raise concerns.

Prevent training has now been accessed in person or online by close to a million public sector workers and volunteers, and is compulsory for many. According to the home office, 92% of those who have attended training ‘left the session with an increase in their awareness of radicalisation and confidence to ensure vulnerable people receive proportionate support.’ Whether this soft outcome justifies the cost and time commitment is a matter for debate. Many doctors, teachers and unions oppose it as ‘unscientific’, worry about being snoops for the state and reasonably believe the funding could be better spent elsewhere.

I have received more mixed feedback, including hate mail from those who believe Prevent is anti-Islam and that I made a grave error of judgement to be a talking head for the training videos. Since 2011, the training has covered all forms of extremism but it’s very rare that an attack by a right wing ‘Christian’ extremist ever leads to calls for Christian communities to ‘put their house in order.’ I have also had wry sarcasm from doctors who don’t rate their chances of diagnosing radicalisation in 10 minutes and sceptics who (rightly) believe Prevent is doomed to sometimes fail while hate preaching is so widely accessible in person and online, our foreign policies remain unethical and our police numbers have been cut.

Prevention of avoidable harm is tough enough in medicine. Every day, psychiatrists in understaffed, overwhelmed services have to prioritise the suicide risks of those who have only just started self-harming and those who have been doing it for years. Social workers overwhelmed by caseload have to juggle the risks to abused children. And police have to decide who on the short list of 3000 terror suspects (and the long list of 23000) deserves closer scrutiny. Unsurprisingly, many who commit suicide have been seen by doctors in the previous few weeks, many children killed by abuse are well known to social services and many terrorists who commit mass murder are well known to police and security services.

‘Prevent’ initially views those at risk of radicalisation as vulnerable children and adults who need ‘safeguarding’ rather than criminalising. Segregation, deprivation and social isolation are clear risk factors for turning to extremist ideology, but some terrorists are doctors and scientists whose grievances are fed by the UK’s military interventions and unethical foreign policies. Others are simply hate-filled individuals who always have, and always will, exist. More research is needed to ascertain how effectively they can be ‘de-radicalised’ by ‘constructive challenge of the hate narrative’, reintegration and psychological support to prevent them progressing to mass murder. No intervention could ever be effective in all cases, so citizens must be supported to speak up if they have concerns about an individual’s behaviour. The charge that Prevent is ‘anti-Islam’ and not trusted in Muslim communities might be mitigated by widening it to encompass speaking up about any serious crime (child-abuse, rape, murder, people trafficking, fraud, building safety, hate crimes) using the Crime-stoppers model. And authorities must listen to, protect and praise those brave enough to speak up.

The experience of whistle-blowers in the NHS informs some of the limitations of Prevent. There is strong evidence that acting swiftly on the concerns of whistle-blowers saves lives and avoids widespread harm. For example, if the Department of Health and the GMC had listened to anaesthetist Steve Bolsin in 1992, when he raised concerns about child heart surgery in Bristol, dozens more babies’ lives could have been saved and brain damage prevented. Despite the horrors of the Bristol, Harold Shipman and Mid Staffs, authorities are still not acting on the concerns of whistle blowers. The long standing and deeply unethical behaviour of breast surgeon Ian Paterson – in full sight of colleagues, private and NHS employers, commissioners and regulators – shows how little we have learned. Some staff did blow the whistle, many should have done more, but no one stepped in quickly to stop a narcissistic liar and bully who was clearly diverting wildly from the accepted guidelines for managing breast cancer. And this is not an isolated example. A urologist who worked at the same trust (HEFT) is under investigation for off-piste prostate cancer treatment for hundreds of patients.

There will be an inquiry, and given the scale of the avoidable harm and failure to act on it, it should be public, particularly given Jeremy Hunt’s promise of ‘no more NHS cover ups’ and to make the NHS ‘the safest and most compassionate health service in the world’. The roots of the scandal will be horribly familiar. Inadequate management trying to stay afloat in the face of prolonged underfunding, focusing on reducing the debt and pleasing the regulators and Treasury rather than investigating serious and obvious malpractice. There will doubtless be bullying of those who spoke up or refused to ‘fall into line’. The regulators too will have been complicit in failing to act.  If doctors are reluctant to blow the whistle on a clearly dangerous surgical colleague, what chance citizens will blow the whistle on friends, family, neighbours and other members of their community who might – on the basis of incomplete evidence – be planning a serious crime? Until we can guarantee protection for people who raise concerns in their workplace or community, we can’t oblige them to blow the whistle. In public services, whistleblowers are still widely bullied and ignored.

In every medical disaster I have covered in Private Eye over 25 years, brave citizens – staff and patients – tried to blow the whistle but weren’t taken seriously. The same is likely to be true in the recent terror attacks and the Grenfell tower fire. How much harm could we have avoided if we had the resources, time and – crucially – attitude to listen to and investigate the serious concerns of those on the frontline? Public Inquiries that report many years after the event change little. It’s time for a truly independent, powerful National Whistleblower Centre that supports, protects and provides legal advice to all citizens raising serious, honest concerns in their workplace and community. It could prevent widespread harm and could save far more money than it would cost to run.