Preventing Terrorism: Understanding and Responding to Vulnerabilities

1. Blackburn with Darwen CCG Protected Learning Time Event 18th June 2015 Pendle Suite Dunkenhalgh Hotel

2. Welcome Dr Stephen Gunn Clinical Lead for Primary Care

3. Care.Data Dr Hereward Brown Clinical Lead for IT and Information

4. Contact Details: Jeanette Pearson: Engagement Lead for the CCG – 07810413402 Helen Sanderson Walker: Comms Lead for the CCG – 07880476109 Janet King: NHSE Regional Head of Intelligence – 07876851841 Justine Banks: HSCIS Project Co-ordinator – 07909093044 Email: Care.data@lancashirecsu.nhs.uk

5. Housekeeping:

6. Agenda

7. Prevent and the NHS Marie Gibbons Regional Prevent Coordinator NHS England (North West) Gordon Mc Geechan Prevent Sergeant Lancashire Constabulary Blackburn with Darwen CCG 18th June 2015

8. Contest UK Counter Terrorism Strategy • Prevent • Pursue • Protect • Prepare Section number NHS | Presentation to [XXXX Company] | [Type Date]

9. Learning Outcomes………. Making the Link……… • Recognise • Respond • Refer • Report NHS | Presentation to [XXXX Company] | [Type Date]

10. Beware of assumptions • There is no single profile of a terrorist – there is no checklist to measure someone against • This is not about race, religion or ethnicity - we are here to consider the exploitation of vulnerable people NHS | Presentation to [XXXX Company] | [Type Date]

11. Prevent in context • Counter terrorism and security Act February 2015 is intended to deal with multiple aspects of the terrorist threat ………. • Ideology –what happens on social media-work with social media to remove /counter narratives • Disrupt /delay travel –intended to protect the vulnerable • Support individuals at risk of being drawn into radicalisation

12. Prevent Objectives……….. • Prevent individuals from being drawn into terrorism and ensure that they are given appropriate advice and support; • Respond to the ideologicalchallenge of terrorism and the threat from those who promote it; • Work with a wide range of institutions and sectors (including social care, health, HE/FE and faith communities) to address risks of radicalisation NHS | Presentation to [XXXX Company] | [Type Date]

13. Prevent Duty 2015 Aim:- Ensure common and higher standards across organisations ensuring that Prevent and Channel processes are effective 3 key themes ………… • Leadership – • Understand risk of radicalisation • Ensure staff understand & build capability to deal with it • Communicate and promote the importance of the duty • Ensure implementation

14. Prevent duty • Working in partnership • Effective partnership working • Demonstrate compliance with the duty • Demonstrate evidence of productive co-operation • Capabilities • Understand radicalisation • Help available and how to access it • Have appropriate awareness /training

15. Twin towers 9/11 London Buses ATTACK COMMUNITIES Fundraising Radicalisation PLANNING Recruitment Vulnerable People within our community

17. Current risks and threats

18. Blackburn with Darwen ………. NHS | Presentation to [XXXX Company] | [Type Date]

19. Susceptibilities / Vulnerablities…..? NHS | Presentation to [XXXX Company] | [Type Date]

20. External Internal Identity Social Exclusions Drug/Alcohol Distrust of Civil society Low self esteem Mental Health issues Religion – lack of theological resilience Links to criminality Changed situation/circumstances Bereavement Rejection Change in appearance Media Propaganda Internet availability Extremist/Terrorist ideology Peer Pressure Availability of travel Foreign Policy Domestic Policy Employment Opportunities Group Identity

21. Your role………..? • NHS Key partner • Identified Prevent Lead / Support network • Policy and Procedure • Training & Awareness raising • Sharing concerns – having a conversation! Safeguarding is everyone’s business

22. Procedure for staff to follow……….. • Concern identified • Share concern with Prevent/Safeguarding Lead (adhere to internal Prevent policy/procedure) • Prevent Lead to have conversation with CCG Prevent Lead • Consider referral to Police Prevent Team for consideration at Channel Panel In event of suspicion of imminent or actual harm to individual(s). Do not hesitate contact the police on 101 or 999 NHS | Presentation to [XXXX Company] | [Type Date]

23. In Summary • Be vigilant • Who is your prevent lead? • Share your concerns with a “conversation” • Use common sense • Act on your concerns

24. Thank you • Marie Gibbons Regional Prevent Lead (north west) NHS England Telephone office – 01138 248 938 Mobile – 07896717647 • Gordon McGeechan Telephone – 01254 353541 / 01772413366 preventteam@lancashire.pnn.police.uk NHS | Presentation to [XXXX Company] | [Type Date]

25. Refreshments and Networking

26. Genetic and Social Implications of Consanguineous Marriage Naz Khan June 2015

27. Objectives of training • To understand the Genetic and Social implications of consanguineous marriage • Presentation of local data on autosomal recessive disorders • The impact of genetic disorders on infant and childhood mortality/morbidity locally • Intervention strategies in East Lancashire • Feedback on evaluation of the service development post and lessons learnt • Develop confidence in initiating discussions about issues relating to marrying close relatives • To be able to identify families for referral • How to make appropriate referrals to the enhanced genetic service • Familial cancer in South Asian communities

28. BWD Population • 2011 census - BWD: 26.4% south Asian (12.1 Pakistani 13.4 Indian) • Growing population - 2001 census 19% South Asian • Average UK towns and cities 4.7% • 27% Muslim in BWD (4.8% average in UK) • 63% of Pakistani’s In Blackburn were born in Pakistan • 25% of deliveries in East Lancashire were to women of Pakistani/Indian Heritage (based on local figures from ELHT trust 2013/2014 • BWD 17th most deprived local authority area in the Country (DCLG 2014) Ref 2011 Census/ONS

29. Measuring mortality in the early years • Measures of mortality relating to early life are critical indicators of the general health of a community • IMR used by organisations including the WHO • Included in NHS Outcomes Framework, Health & Wellbeing Strategies • Allows comparisons between regions • Can be used to track improvements over time

30. Definitions • Infant Mortality Rate (IMR) is the number of deaths of infants under one year of age per 1,000 live births. • e.g. In 2012 there were 2300 live births in BwD and 10 deaths in infants < 1 year IMR=4.3 per 1000 live births • Neonatal mortality rate is the number of deaths of infants under 28 days per 1000 live births • e.g. In 2012 of the 10 deaths under 1 year in BwD. 7 were infants < 28 days NMR= 3.0 per live births

31. Infant mortality rates-by countrySource: OECD health data and WHO Global Health Observatory]

32. Deaths by Categoryin BwD Following the review by CDOP a category for cause of death is assigned to each case. 30/71 (42%) cases were due to either: Chromosomal, genetic and congenital anomalies 26/71 (37%) Perinatal/neonatal events 6/71 (8%) cases were due to SUDI

33. Blackburn Infant Mortality 2013-2014 : 6.5 per 1.000 significantly higher than national and North West average of 4.3 and 5.0. Childhood mortality 2013-2014: 16.6 higher than the national average of 12

34. Consanguineous marriage Source: World Health Organization 1985 Advisory Group on Hereditary Diseases. Community approaches to the control of hereditary diseases. Unpublished WHO document: HMG/WG/85.10. Available at: http://whqlibdoc.who.int/hq/198586/HDP_WG_ 85.10.pdf Genetics Communication Diversity Customs governing first cousin marriage (GP Murdock, Ethnographic Atlas, 1967) Latitude Consanguineous means of the same blood Consanguineous marriage is marriage between blood relatives 20% of the worlds population live in communities that favour consanguineous marriage 8.5% of all births are to parents who are consanguineous 25% of cousin marriages in the UK are among white majority population

35. Consanguineous marriage Customary in many parts of the World Pakistan, Bangladeshi, Middle East, Some Indian, Irish travellers, Some Refugee groups. Pakistani Heritage have the highest rate of cousin marriage (at least 55%) In BwD, 95% of Asian parents with an affected child were in a consanguineous marriage Integral Cultural and social practice Associated with Islam but neither encouraged nor discouraged by Islam

36. Reasons why people consider consanguineous marriage Cultural Strengthens family ties and support systems; keeping connections Ease of finding a more suitable match and having more stable marriages Maintains a woman’s status within the family hierarchy Maintains family lineage Preserves culture and tradition Financial benefits Obligation to kin Economic / Immigration

37. Health Issues associated with Consanguinity Increased risk of genetic disorders High infant mortality and childhood morbidity Limited engagement with Health Services Lack of awareness of inherited disorders Stigmatisation Communication issues

38. Cousin marriage and inherited/genetic disorders Does not influence chromosomal abnormalities, sex linked or dominantly inherited disorders Impacts exclusively on recessively inherited disorders Populations where partner choice is random A.R disorders random and scattered Communities that practice consanguinity AR disorders cluster within extended family groups

39. Genetics Our bodies are made up of millions of cells. Cells contains genes 2 copies of every single gene One copy inherited from mother, one copy inherited from father 30,000 genes Most people are carriers for a at lease 1-2 recessive disorders Carriers healthy Population risks of being a carrier for some conditions Rare recessive disorders

41. Autosomal recessive disorders 2-3,000 known autosomal recessive disorders Phenylketonuria (PKU) Congenital adrenal hyperplasia Spinal Muscular atrophy Many biochemical/metabolic disorders

42. Unrelated couples: chance of a recessive disorder

43. Couple 1st cousins: chance of a recessive disorder

44. What to do? 10-15% of consanguineous couples are at risk 85-90% of consanguineous couples are not at risk Discourage consanguineous marriage at the population level? Try to identify and inform those at risk?

45. Try to identify and inform those at risk?(A family-centred approach) WHO recommended approach In families transmitting a disorder, an affected child will be born once around 12+ cousin marriages Paediatric and genetic counselling services are aware of all diagnosed affected children So, Start with the affected person Draw up an extended family tree Offer information to all family members Offer carrier testing to all members Aim for married couples & children & young people Provide information and long-term support

46. Dr Benson’s Study (2002) Two Part Study: The Range and Prevalence of Recessive disorders in the Blackburn population. Health Perceptions and families response to Genetic Information

47. Results of Dr Benson Study Incidence of definite recessive disorders in the Asian population was 12 times that of the incidence in the white population. 83 different recessive disorders diagnosed. Where data recorded 95% of Asian parents were consanguineous. 13 recessive disorders per 1000 Asian births Several Asian families with 3 or more affected children

49. Service development Bid DOH under the Genetic White paper (2003) To improve the clinical service available to South Asian origin who have children affected by A.R disorders. To reach extended family members in consanguineous families so that they understand their own risk of having affected children and can make informed reproductive choices including arranging future marriages within/without the family.

50. Evaluation Of the 72 questionnaires distributed, 46 were completed. The questionnaires were analyzed using SPSS. Overall the service to families has been received very positively