The book’s second strand argues that, at its core, the act of whistleblowing is a moral activity. It has moral consequences, for good or bad, for the person raising concerns, and the person(s) or practice(s) those concerns are raised about. Yet the ethics and morality of whistleblowing, or of practices and behaviours and what goes on in the workplace, are seldom construed as such. The concept of ‘morality’ doesn’t play out well in political, public and professional discourse that is hell-bent on reducing genuine understanding of what went wrong and why, to reprisal, retaliation and retribution, as well as production of the obligatory action plan with accompanying statements that lessons have been learned. It’s too academic, too vague, too well-meaning to get the attention of the politician needing a headline. But the ethics of health and social care are the core, the basis, the means and the infrastructure of how we do our business together as people who need the care of others at points throughout our lives.
To give this traction, the book considers the four elements of an ethic of care – attentiveness, responsibility, competence, responsiveness – originally developed by Fisher and Tronto (1990). These four elements are used to propose an ethical structure that drives, imprints and manifests an ethic of care throughout health and social care delivery. This includes its leadership, management, policy-making and regulatory framework. Laying duties to deliver an ethic of care onto just one part of this structure – the individual delivering health or social care – will not ensure ethical care, without the wider health and social care system underwriting that duty, and supporting it explicitly, in word and deed.
Hence, and third, the book’s focus and locus takes in, most certainly, the policy and regulatory system that frames the delivery of health and social care services. It is not a book about practice or practitioners, although failures of health and care find form there, at least superficially. The book, overtly and unequivocally, places the politics, policy and regulation of health and social care into analysis of the ‘failure frame’, and the response to whistleblowers who speak out. What happened in Mid Staffordshire NHS Foundation Trust was not a little local difficulty. It was cultural, systemic, and unambiguously implicated the social policy zeitgeists that surrounded, and corroded the delivery of decent healthcare to so many people.
Mostly UK focused, the book draws on learning, experiences and examples of whistleblowing internationally. Although it does not rehash disasters and scandals in health and social care (they come and go and will happen again if we continue to do what we do), three particular ‘failures’ of health and social care in England crop up from time to time throughout the book. These are the disasters that were the (now dissolved) Mid Staffordshire NHS Foundation Trust (then part of NHS England); Winterbourne View (a private healthcare assessment and treatment facility for people with learning disabilities); and the handling of systematic, prolonged, organized sexual exploitation of children and young people by Rotherham Metropolitan Borough Council and its partners. These three failures are discussed to pull out some common features of organizational responses to whistleblowing and the whistleblower: silence, denial, blame, retribution and turning those blind eyes and deaf ears.
CONUNDRUMS AND QUESTIONS
Overall, the book considers a number of conundrums and questions:
•What is whistleblowing, and why is ‘whistleblowing’ such a loaded word?
•Why don’t people who are paid to lead, manage or provide professional or practical health and social care always raise concerns of poor or harmful practices when they encounter them?
•Why is demonstrably poor practice sometimes not ‘seen’, ‘heard’ or recognized as such in the workplace? Why the silence?
•What happens in the workplace, at the time and subsequently, to those who blow the whistle?
•What is organizational culture, and what part does it play in what goes on in the workplace, on right- and wrongdoing, and whistleblowing?
•What would ethical care, practice, policy, regulation, leadership and management look like in health and social care?
•How can ethical health and care systems be created, bedded in and sustained?
•How can ‘raising concerns’ become a routine, everyday, expected feature of how ethical health and care systems operate?
These questions are discussed throughout the book. Chapter 2 starts that discussion with an overview of whistleblowing, and what is known about the characteristics of whistleblowers. The protection afforded the whistleblower by UK whistleblowing legislation and policy is considered, as are acts of retaliation, retribution and their consequences for the whistleblower.
Chapter 3 moves the spotlight onto features and facets of organizational culture and, in particular, the whistleblower’s action in bringing ‘undiscussable’ aspects of organizational life into the open. This chapter looks at how wrongdoing becomes normalized, rationalized and institutionalized in organizational culture. Individual moral agency of the individual versus the power of a group in shaping moral action are examined, as are the influences on speaking out or staying silent about wrongdoing. This chapter’s elaborate metaphor mix – blind eyes and deaf ears abound in the company of bad apples, elephants in the room and the emperor’s wearing of clothes – hints at the power of language both to contain and to name that which we are unwilling to face head on.
Chapter 4 continues this theme in its discussion of the ‘shapes and sounds’ of organizational silence and denial of wrongdoing. The propensity of ostensibly normal, well-adjusted people to inflict suffering on others when ordered to by authority is considered. The response of Rotherham Metropolitan Borough Council to the prolonged, systematic sexual exploitation of children and young people, over many years, is reviewed. Six ‘devices of denial’ used by the Council are identified to illustrate a systemic, institutionalized denial of harm.
Chapter 5 looks at the social phenomenon that is ‘bystanding’, or standing by and doing nothing when harm is perpetrated. Some of the complex features of self-deception involved in a tacit tolerance of poor, harmful or criminal practice are identified, including the human capacity to overestimate personal ethicality and morality.
In a change, if not a lightening, of tone, Chapter 6 discusses two commonly proffered remedies to encourage whistleblowing: paying people to speak up about wrongdoing, and laying a ‘duty to whistleblow’ on professionals. In light of the foregoing, these two ‘remedies’, often to be heard in post-disaster ‘this must never happen again’ pronouncements, are discounted. Ill-informed and simplistic, both fail to grasp the complexity, for the organization and people in it, present when the whistleblower steps up to speak out about poor health and social care.
Chapter 7, on whistleblowing and ethical health and social care systems, makes the case for an ethic of care to be imprinted throughout