Intended for healthcare professionals


Is there any place for counterterrorism in the NHS?

BMJ 2017; 357 doi: (Published 26 April 2017) Cite this as: BMJ 2017;357:j1998
  1. Anne Gulland, freelance journalist, London, UK
  1. agulland{at}

The NHS is obliged by law to report people it believes are at risk of becoming terrorists. But, on the ground, Anne Gulland finds this Home Office strategy is having little or no impact in the health service

A terrorist attack killing five people in Westminster last month put the government’s counterterrorism strategy under the spotlight. One of the key planks is the Prevent strategy, which aims to identify people at risk of radicalisation and intervene before they are drawn into committing any violent acts.

Doctors and other health workers are included in the 2015 Prevent strategy, which places a statutory duty on schools, universities, and NHS trusts to identify individuals—both patients and colleagues—they believe are at risk.

It’s a move that has provoked fierce debate in education, but in health the duty seems to have been introduced with little fanfare. However, concern about the strategy in the NHS is growing—both about what it means for doctors and whether staff are equipped to identify individuals who are “at risk.”

New data collected by The BMJ has uncovered low levels of referrals to Prevent since the duty took hold (box). Figures obtained by freedom of information requests from 59 acute trusts in England found just 75 referrals to the programme between 2015-16. A further 74 trusts replied to our request but withheld information on referrals; some because the actual number of referrals was so small, others on security grounds. Mental health trusts in England recorded a much higher level of referrals: 23 trusts (40%) were willing to provide data, showing a total of 254 referrals. This higher number is not surprising given that psychiatric patients are more likely to discuss such issues with their doctor.

Our data also show that many NHS staff are ill prepared to deal with the Prevent …

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