A new report from Medact and the University of Warwick reveals the extent of new non-traditional methods of surveillance and counter-terror policing in health, education and social care. The Counter Terrorism Clinical Consultancy Service (CT CCS) raises serious ethical questions for potentially vulnerable members of society, their rights and agency – fundamental components of human security. Report author Charlotte Heath-Kelly outlines how the CT CCS came about, how it works and the ethical issues it raises.
Between March and September 2017 there were five terrorist attacks in the United Kingdom. The sudden occurrence of a suicide bombing at Manchester Arena, a vehicle attack on Westminster Bridge, a vehicle attack on Muslim worshippers in Finsbury Park, a marauding knife attack in the London Bridge area, and a partial detonation of a device on a West London tube train shocked MI5 and Counter Terrorism Policing into conducting internal reviews of what happened and whether any chances to stop the attacks were missed.
While the internal reviews by MI5 and Counter Terrorism Policing are classified, the Intelligence and Security Committee (ISC) of Parliament has published an overview of many of the findings. The major concern for the reviews was that several of the perpetrators were known to MI5 or Prevent, but had been ‘closed’ as subjects of interest for the intelligence agencies or were coming to the end of their Prevent support package. Effectively, while these perpetrators had been on the radar of the security agencies, they did not present signs of serious risk to the public and were allocated low threat levels.
Beyond surveillance: ‘Revolutionary’ changes after 2017
The recommendations of the reviews include some truly novel solutions. After pointing out that MI5 and Counter Terrorism Policing are operating at capacity for surveillance of subjects deemed to pose a threat to the public, the findings of the review do not recommend extending that surveillance capacity. Instead, revolutionary changes to the sharing of national security information are recommended – including passing some of that information to frontline services that are engaged with the person, locally. This is referred to, by the ISC, as ‘sharing information beyond traditional boundaries in order to strengthen the ability to connect information’. Of course, the reference to connecting information is crucial here, as the frontline workers engaged in this process are expected to contribute their own information to the intelligence picture.
The sharing of information with frontline workers (and the receipt of intelligence from those health, social care, prison and probation and education professionals) is commonly managed by Counter Terrorism Policing. The existence of MAC (Multi Agency Centre) is acknowledged in the latest CONTEST Strategy and is a multiagency group which manages persons who MI5 have ceased to have an active interest in – but who may still be engaging with extremism. Counter Terrorism Policing lead these MAC panels, organising ‘nudges’ from local services that might offer a more productive direction to the person being risk managed. This work occurs covertly and the person, who is no longer under investigation, has no idea that their services from local providers are being managed by Counter Terrorism Policing, nor that classified information has been used to facilitate this process.
There are also similar programs which cater to persons who have not been under MI5 investigation but have simply been referred to Prevent by a co-worker, teacher, or healthcare professional. Prevent is the UK’s counter-radicalisation referral program which operates in the pre-crime (no-crime) space to deal with people’s extremist attitudes. Recent research has shown that there is a covert pathway within the Prevent process, called Police Led Partnerships (PLP), which deals with people who are ‘unsuited’ to Local Authority management. A badly redacted FOI response from the National Police Chiefs Council was released, which showed that Counter Terrorism Policing consider people ‘unsuited’ to the Local Authority Prevent if they have: previously refused consent for mentoring under the Channel scheme to address their views; undertaken a stickering or leafleting campaign for a radical cause; have a relative or close associate under active counter-terrorism investigation; or are a committed recruiter to an extremist cause. These categories of Prevent-referred persons go instead to PLP – where Counter Terrorism Policing manage the allocation of services and support to PLP subjects, through frontline services, to ‘nudge’ them towards an approved life course.
Healthcare and two-way information sharing
But how do Counter Terrorism Policing officers know which services to offer, through PLP and MAC, to, as they see it, correct the behaviours and attitudes of those under covert management in the community? They have developed a service which allows consultant psychologists, consultant psychiatrists and mental health nurses to tell them.
The Counter Terrorism Clinical Consultancy Service (CT CCS) has operated across England and Wales since April 2024. It is based on a pilot program known as Vulnerability Support Hubs, which ran from 2016 until 2024. A small staff of psychologists, psychiatrists and mental health nurses, all with security clearance, work inside Counter Terrorism Policing HQs – ‘formulating’ how the subject of police interest is affected by mental illness, neurodiversity and their life situation, and making suggestions as to the support which could benefit them. However the clinicians never meet or assess the person, so the process is neither evidence-based nor ethically rigorous (given the absence of consent and the ethical code issued by the World Psychiatric Association, which states that medics should have no part in contributing opinions about radicalisation to police).
A recent study by Medact and the University of Warwick has detailed the operations of the CT CCS, using interviews with a senior clinician and senior police officer working there. The interviewees confirmed that they contact frontline NHS workers (GPs and psychologists, mainly) and pass them a ‘gist’ of national security information, to explain their interest in a patient. They then request medical information from the healthcare professional. This information is then ‘formulated’ with police in the CT CCS, alongside the full remit of information from police databases. This ‘formulation’ is a narrative explanation of how a person’s medical conditions, neurodiversity and life circumstances might sustain their engagement with extremism – and crucially lends itself to corrective interventions through the police-led MAC and PLP.
Ethical concerns
There are many concerns about these practices. Firstly, the covert management of non-criminals in the community by national security agencies, through local service providers, is a significant extension of pre-crime (no-crime) policing controls into private life. Secondly, the best practice guidance for ‘formulation’ (issued by the British Psychological Society) states that it is a medical technique reliant on consent and co-production with the client – and the CT CCS never meet the person they profile, nor obtain their consent. Thirdly, the NHS Constitution commits to informed consent before any medical procedure is used, and promises to keep patients informed about any use of their confidential information – commitments which are breached in CT CCS practice. Finally, there is no independent oversight of the CT CCS, its release of national security information to GPs and psychologists, nor its use of secretly obtained medical information.
Rather than extending the surveillance capacity of MI5 or Counter Terrorism Policing directly, the reviews of the 2017 attacks have instead expanded surveillance relationships into frontline services – where healthcare professionals, social services, probation officers and teachers serve on multiagency panels, led by officers from security agencies, and share confidential information with them about the daily lives of persons of interest. With the development of such profound relationships of information-sharing with frontline services, the traditional methods of surveillance have taken a back seat. It is difficult to see how trust, agency and rights – essential components of human security – can be respected in this ‘national security’ programme.
The views and opinions expressed in posts on the Rethinking Security blog are those of the authors and do not necessarily reflect the position of the network and its broader membership.
Image Credit: Image from There Is No Alternative, an exhibition by artist Navine G. Khan-Dossos, at The Showroom, London, 5th June–27th July 2019, photographed by Dan Weill Photography. Report cover design and layout by Sujata Aurora/Gratuitous Graphics
