I was a healthcare professional and have resigned from my professional body largely because it attempted to impose an enhanced umbrella

CRB check on me. The other reasons were that it had come to an arrangement with an academic publishing company which would reduce the availability of information arising from medical research and that it was acting in a way which could not guarantee the quality of degrees in the subject. Neither of these reasons are strictly relevant except to demonstrate that there is no question of my competence and professionalism in this area - I have nothing to hide and no axe to grind. The decision to resign from the body has barred me from future practice in my chosen profession, and I would have done the same regardless of the precise nature of my profession, be it the law, teaching or accountancy, by simple virtue of the fact that the very existence of the Criminal Records Bureau system as it currently operates is incompatible with professional ethics as a whole. What follows is an attempt to argue the case for this from a partly personal and partly detached perspective. I went into my profession because I wanted to help people restore and maintain their health and well-being, do worthwhile work and make a positive contribution to the world with a clear conscience. I would also say, and this is relevant to the point in hand, that the most important skill in medicine is establishing a rapport with patients, being on their side, listening to their needs and serving them humbly and attentively, at least in roles where one is physically in ones patients presence. Laboratory and research work, among other things, is of course valuable, but that is not my role, and in the role I chose these things are primary. To be a competent carer, one needs to be a people person. Medicine is a craft and an art as well as a science. Textbooks can provide a firm theoretical grounding for ones understanding of disease processes but the real world of health and disease is messy and complex compared to ink on paper and they can only really furnish one with a sketchy and simplistic outline of how people can be unwell. The most important diagnostic instrument is the emotional, nuanced, analogue spirit of skill, attentiveness and care which one gains through experience and true listening - in other words, intuition. Its a privilege to see a patient and ones behaviour towards them must be governed by honour and trust, implicit in the medical role. It is hard to imagine a situation where it would make sense for such trust to be abused, and the gatekeepers to such roles, such as interview panels, mentors and tutors, should assess potential healthcare workers on this basis. That much is appropriate. All of this, of course, is intangible and imponderable and there are many problems and conflicts. Among the obstacles to addressing a patients needs effectively is the nature of their life situations, living as they are in an imperfect world where they may be overlooked, ignored or lack a sense of meaning and purpose in their work or life generally. As professionals, we are obliged not to make this worse. Near the beginning of the Hippocratic Oath, by which we are all governed at least in spirit, is the phrase First, do no harm. Contributing to a situation where bureaucracy and a deterioration or the absence of face to face relationships are a significant drain on quality of life definitely counts as doing harm. This is, in my view, precisely what Criminal Records Bureau checks do. They undermine the fundamental I-Thou relationship without which we cannot be whole, or in other words, healthy. The history of CRB checks with my professional body is as follows. A person guilty of possessing child pornography attempted to join the association and as a result the council which runs it, which is democratically elected and to which certain decisions are of course delegated, made a decision to impose enhanced umbrella CRB checks on all members. Many members already had CRB checks due to other roles than their paid work, but up until the time of writing at least, these are not transferable: they cannot be applied to other roles than the ones which initially triggered them. An umbrella CRB check is more expensive than an individual enhanced check, but lasts three years and is cheaper than three annual ones. There were various objections to this decision from the members, including lack of consultation, the price of the check relative to the rather low income of many of us and concerns about the security of sending five pieces of identification through the post to an unknown, non-governmental organisation. Although I found it very hard to reconcile what my association was asking me to do with my conscience, I reluctantly paid the 55 fee and sent them the requisite items of identification including a birth certificate, passport and original bank statements - copies were not accepted. Over a year later, they wrote back to me having retained my identification and stated that I had not paid them. Since they made this claim, which I do believe was made in good faith, they failed to carry out a CRB check. I had evidence from my records that they had in fact been paid, but was completely unsurprised by this turn of events. I quote it as evidence that as an organisation they did not operate in a manner which I found at all reassuring as to their competence and trustworthiness. It simply confirmed my suspicions. Rather than attempting to resolve this situation by paying them a second time, I chose to leave my professional body. Since the check was organised through that body and they are not transferable, it would not have been possible to use any other organisation to have a check carried out for this purpose. Competition in this situation does not exist and there is therefore less motive for them to provide good quality service. I cite this as evidence that their integrity is limited, perhaps inevitably as a result of their position as an unchallengeable and unaccountable body making judgements about others. In detail, I resigned because members were not consulted and there was an assumption by my association that the process should not be resisted, i.e. that it was ethically compatible with our practice. Having said that, I do not see them

as responsible as it is common for decisions to be made at a higher level, such as government, to be carried out by people at the bottom who have little choice but to do their dirty work. For instance, a poorly funded state education system could result in excessive class sizes which turn teaching into an exercise in classroom control rather than education [Tell me if this is accurate because obviously Im not a professional teacher and you are. Maybe theres a better example]. Rather than sending more money to an organisation whose very purpose is fundamentally misconceived, I chose to resign. I am going to assume that there are people who really would otherwise have abused children or vulnerable adults as a result of not having a CRB check, that is, I hereby assert that for the sake of argument, the CRB succeeds in preventing the abuse of vulnerable people. I make this statement to circumvent the argument that this justifies the checks regardless of any counterargument. My assumption in detail is deliberately extreme: that the non-existence of the CRB would result in deaths and ruined lives. Given that assumption, it is nonetheless the case that a world in which the CRB exists in its current form at least is worse than the same world without it. This is because we are biassed in favour of the idea that action taken which prevents harm is better than inaction which enables harm to occur, and we do not look at the other side of the coin: that action aimed at preventing harm can itself be harmful, that inaction which allows harm to occur can also be beneficial and that the harm caused by action can be greater even if it succeeds in preventing other harm. Here are a couple of examples from medicine. Mammograms are X-rays used to detect breast cancer. It has been suggested that all women should be screened for breast cancer in this way in order to detect it in its early stages and prevent death and suffering. However, since X-rays are ionising radiation, they carry a certain risk of causing cancer themselves, and the more women are screened, the more likely there are to be cases of breast cancer actually caused by mammograms. Another example is the use of sunblock to prevent skin cancer. Since this cuts down on exposure to ultraviolet light, it can also cause vitamin D deficiency, thereby increasing the risk of other life-limiting conditions such as multiple sclerosis. It can be seen from these examples that it is a non-sequitur to assert that successfully preventing a negative outcome is always better than the harm it may cause. The question is one of probabilities combined with an assessment of how bad the relative outcomes are. In order to address this, medical and other tests are themselves evaluated in terms of specificity and sensitivity. Specific tests produce few false positives: there are relatively few cases of detecting a problem where none exists. By contrast, sensitive tests produce few false negatives: there are relatively few cases of giving someone a clean bill of health when they are in fact ill. Each test has the problem the other attempts to avoid, although they are not mutually exclusive. In theory, there could be tests which produce many false positives and false negatives, but if this was established it would probably not be wise to persist with their use. A positive result from a sensitive test can lead to unnecessary and potentially harmful treatment such as surgery resulting in wound infection or fibrous adhesions or being on inappropriate medication with undesirable side effects. A profession should be a vocation - a calling. Consequently, though they need detachment, professionals need to apply the same principles to everything which influences their working life and maybe beyond that to their life generally. It would be absurd, for example, to draw a line around a medical centre and allow the rest of the world and ones patients lives to continue in a manner which contradicts the principles whereby one works. Suppose a patient works in a factory known to be riddled with asbestos. It might be appropriate to try to remedy this situation by trying to ensure this was safely removed rather than simply waiting for people to succumb to mesothelioma and managing the terminal stages of this cancer, caused by asbestos. I assume there are analogous situations outside healthcare. Therefore, professional ethics require one to consider the efficacy of CRB checks in the same terms, using evidence regarding their sensitivity and specificity in the same way as one might evaluate any other test which influences the effectiveness of the health service. Perhaps in teaching, for instance, it might be appropriate to evaluate competitive and cooperative learning situations as to their relative effectiveness with different genders and act accordingly. The same presumably applies to CRB checks for educational professionals. Heres why. Imagine the following scenario. An experienced and competent pediatrician who is in fact innocent of child abuse undergoes a CRB check which turns out to be sensitive according to the definition given above. It falsely flags her as guilty and she resigns. She is replaced by another genuinely innocent but less experienced and less competent pediatrician who has to take on duties for which he is not ready. He goes on to miss conditions which she would have detected, treat other conditions inappropriately, and a childs death occurs which would not have done if his predecessor had stayed in her job. Furthermore, having been placed in such a position too early, the profession loses a valuable future doctor because he has left the profession under a cloud. At least two peoples skills and value to society have been lost. To me, this is a fairly conservative and entirely plausible scenario, and crucially, it gives the lie to the phrase If it saves one child. The CRB may very well have saved a child. In this situation, they have also killed at least one child, possibly many more.

It seems to be assumed for some reason that these checks work perfectly, that no-one ever slips through the net, that noone is ever falsely accused, and that carrying out these checks is harmless. This is unlikely to be the case. In a situation of evaluating or assessing another such check, for instance continuous assessment or examinations in education or mammograms or the use of sunblock in medicine, quantitative, evidence-based research exists which enables one to decide to use or reject them. Evidence in the case of the effectiveness and hazards associated with the operation of the CRB is not forthcoming. Therefore, professional ethics require that they be resisted because prima facie, they seem to reduce the quality of service to clients. A second popular expression placed alongside If it saves one child... is If you have nothing to hide, you have nothing to fear. This is clearly false. It assumes shared values and perfectly functioning apparatus. I do of course agree that the physical and sexual abuse of children and vulnerable adults is very wrong indeed. In my line of work, I frequently encounter people who have experienced this and I share the value that it needs to be prevented. However, other values differ and lazy thinking can lead to misplaced suspicion. For instance, in South Ronaldsay in 1991, police and social workers came to suspect incorrectly that Quakers were responsible for maintaining a pedophile ring and practicing Satanic ritual abuse. The children involved were subjected to questioning liable to elicit false information regarding their possible abuse. When individual adult Quakers were questioned, their tradition of having no leaders and sitting quietly in meditation waiting for the Holy Spirit to move them, perhaps due to its unfamiliarity, was considered in itself to be further grounds for suspicion by the police. The absence of a formal leader may have been interpreted by the authorities to mean that there was nobody in the organisation with the leadership necessary to prevent child abuse. To a Quaker, it might mean that there was less opportunity for a concentration of power in leadership to become corrupt, and in fact recent allegations against the Roman Catholic church suggest that this is a well-founded concern with respect to child sexual abuse. This is, in any case, a clash of values which led to an unwarranted degree of suspicion and harm to an innocent religious group, whose children were taken into care as a result. These people had absolutely nothing to hide in this respect, but they absolutely did have something to fear. A related issue is that of perfect efficiency. We are being told to place our trust in organisations of a kind which have a poor record of preventing harm and a substantial record of causing it. This can be illustrated with reference to the Child Support Agency as it was initially constituted after its foundation in 1993. Its aim was honourable: to prevent harm to children by ensuring that absent parents did not shirk on their financial responsibilities to them. Unfortunately, it appeared to result in errors, delays and inaction along with endangering single-parent families and reducing their income. More than half its income went on administration and the length of time taken to deal with each case increased sixteenfold over a period of three years. The agency fed on its own inefficiency and became part of an industry depending on childrens hardship. It has a reputation of harming those it is intended to protect. I would allege that the CRB is similar. The suggestion that if we have nothing to hide, we have nothing to fear would imply that the CRB never makes mistakes and that everyone connected to it is both well-intentioned and unfailingly successful in bringing those good intentions to fruition. My own experience shows that this is not the case. They make mistakes. This is hardly surprising since they are human, but an organisation with the potential to do so much harm by making a mistake, which is alleged to have happened at least 20 000 times as I write these words, would have to be superhumanly infallible to justify its existence, and we all know that such organisations do not exist because they consist of limited, imperfect human beings like ourselves. Therefore, the establishment of any such organisation needs to be undertaken with forethought, particularly with regard to its mere existence, since that existence is inherently hazardous. I shall now cover a number of other points. At the moment at least, there is a requirement for each role involving contact with vulnerable people to require a CRB check. So, suppose for example there is a schoolteacher who volunteers as a scout leader, works with a church youth group and manages a childrens football team. Each of those roles requires a separate CRB check. Now suppose this person drives to and from work, rents a van to move sports equipment to and from the playing field and drives a minibus for scout trips. For all of those, where a risk of death is of course involved to the same children for whom she holds the CRB checks, she needs a single clean driving licence. With the best of intentions - few people drive around maliciously intending to injure or kill people - there is a safety risk to those children and also adults which is as great as the risk of child abuse. Deaths and permanently ruined lives are possible as a result of driving. Of course, nobody is going to claim that people generally have the intention of harming or killing people with their driving, or even being negligent enough to endanger them, on the whole. Similarly, to go to any country in the EU and sometimes beyond, British subjects require a single passport. It is of course possible that they are responsible for violent crime or smuggling, again risking the death, injury and permanent blighting of the lives of people in those countries, but again the level of suspicion here is relatively low and they do not require multiple passports. These two examples illustrate two things. One is that the requirement for separate CRB checks for each role makes no

sense unless it also makes sense to require separate driving licences and tests for every vehicle one drives and separate passports for every country one visits. The other is the absurdity of assuming the risk is so high. Were not all assumed to be drug smugglers, terrorists and motorists with murderous intent. That would be insane. The level of harm is no lower in these circumstances: a drug smuggler can be responsible for thousands of deaths, a motorist can easily kill a child as a result of a moments inattention and so forth. Therefore, why is the level of suspicion so high. Two other factors arising from this line of argument are that there is presumed guilt in these situations and that the cost of CRB checks, financial and otherwise, constitutes a tax on altruism. We have long had the assumption of presumed innocence in this country. One is considered innocent of a crime until proven guilty. Clearly there can be grounds for suspicion if one was in a particular place at a particular time, is holding a smoking gun and the like, but the burden of proof is on the prosecution. It is also held that the nature of justice is such that it operates independently of the principle of the greatest happiness of the greatest number: the fact that someone is unaware that there is a minimum wage and happy that their employer is paying them a relative pittance due to their ignorance that they could receive more does not imply that the situation is fair, and most people would say that justice is a separate and possibly overriding principle in such circumstances. CRB checks go directly against this presumption of innocence. We are all assumed to be guilty unless we pass a check. This principle is actually written into the constitutions of many societies, yet the CRB is allowed to violate it. There is also Blackstones Formulation: that it is better that the guilty go free than that the innocent are punished. The situation as it stands both punishes the innocent and allows the guilty to go free: there are plenty of cases of people being found guilty of abusing those in their care despite having passed a check successfully. Now for the tax on altruism. The teacher I mentioned above is giving of themselves freely to their community. Each one of those roles now costs her something like 36 a year. She is being fined for her contribution to the good of society. Now extend this to charities. Suppose I contribute to a childrens charity which involves adults extensively doing voluntary work with children. Each person who does that will now cost that charity the price of a safety check and much of the money I have donated to that good cause will go directly to the organisations running the checks. Where people bear the cost themselves, they may be priced out of the market, and where that voluntary work could have led to employment as, for instance, a teaching assistant and to the good of society, that role is lost to us all simply because of the existence of these organisations. Is that a better society? The CSA was once an example of a government body which profited from misery, though of course the situation has now improved. This often happens and is sometimes unfortunately necessary: my own profession makes its living from the suffering of others. However, when these circumstances exist, it seems fair to expect that the minimum profit is made to prevent it from becoming a growth industry. Otherwise we are creating paid work for people who are only in employment because children are suffering, and that connection is unhealthy. It means, for example, that there is a risk of the organisation to extend its remit to other areas, to encourage suspicion and to do little to relieve that suffering because the longer that suffering continues, the more money they have. It is to say the least in poor taste to offer a professional body a special deal where members can buy a certificate in bulk as it were to state that they are not guilty, a presumption which natural justice entails should be free. Nevertheless, this is what they do. The three year umbrella certificate is about half the price of an annual enhanced disclosure. Nevertheless, someone could commit a relevant crime in that three year period - presumably the probability is tripled - and be unchallenged for up to three years. In other words, the value is to the professional and not the clients, and seems not to be connected to the actual safety of the clients. It means that people are either being overcharged or subsidised by others. This is not the kind of thing which should ever happen in such an area. It is reminiscent of Papal indulgences changing hands for money - I will forgive you if you pay me to. This buying of innocence in bulk also reveals another problem: this is like a Papal indulgence in that it merely symbolises innocence, and in doing so, undermines the exercise of intuition and good sense when employing or otherwise engaging the services of an individual. People could become more concerned about a valid certificate than their own intuition. For instance, the temptation is created to allow an employer who has failed to prevent abuse to the clients of their organisation, such as children at a nursery school - lets make it absolutely clear that we are talking about human beings here - to make the excuse that all their employees had valid certificates. These valid certificates, incidentally, did nothing to prevent the abuse of adults with learning difficulties at a local carehome or the neglect of geriatric patients in hospital wards. All of the workers involved with those particular vulnerable adults would have had CRB checks, and could have passed further checks after these abuses had come to light. Nothing about the CRB could have prevented that abuse: those workers and their employers had bought their innocence. This is how this process undermines the operation of intuition and good sense. So the question arises: what would I have instead? The problem is, as is so often the case, that this is an attempt to address the symptoms of a social problem after the fact. As a healthcare worker, I am aware that prevention is better than cure. If people went out into the world with a sense of honour and decency, and these virtues were recognised and understood for what they were by the general public and those charged with responsibility for hiring and firing, the

flimsy excuse for the existence of this harmful process would be widely recognised as laughable. Spiritual rather than material values and a recognition that we are each personally responsible for others and that we can and must do better is the answer to this. Even if it isnt, I hope Ive made it clear that the CRB is deeply damaging to society and part of the problem, however well-intentioned it may be.