Most whistleblowers don’t work in their employment field again. Some lose their homes, profession and health, to depression, alcoholism, family break-up. Still more, the greatest shock to the whistleblower is likely to be what they learn about the world in its reaction to their speaking out (Alford 2001).
These paradoxes lie at the heart of whistleblowing and they affect us all. That rugged, autonomous individual, so beloved of media or marketers, is quashed when the organization mobilizes its ‘vast resources in the service of the individual’s destruction’ (Alford 2001, pp.3–4). Alford, a psychoanalyst and political scientist, suggested we listen to that individual – the whistleblower – so that ‘we may learn something, not just about individuality, but about the forces that confront it’ (Alford 2001, p.4). This book sets out to contribute to that learning.
WHAT THIS BOOK IS ABOUT
This book starts from ‘the point’ (in both senses) of these paradoxes, that is, their location and their meaning. Its premiss is this: unless and until we wake up and face in to see these paradoxes at play in responses to whistleblowing, then the familiar, formulaic responses to shocking failures in health and social care – expensive public inquiries years after the event; retribution and silencing of those who spoke out, ‘tightening up’ of standards and targets that missed the point first time round, to name but some – will fail those who use those services, and those who speak out about problems in them. The irreplaceable public goods that are publicly-funded health and social care services are simply too precious to allow a systemic wilful blindness to these paradoxes, and their consequences, to prevail. Shining a light on those and on their systemic backcloth is what the whistleblower does and, in so doing, pays the price. Maybe it’s time for those who are elected to serve, lead, regulate and run those organizations to look, listen, and share that load a little.
Three distinct strands give shape to the book’s architecture. First is the significance of organizational culture and leadership in shaping the possibility that people will step up to speak out about poor practice. Organizational culture and its leadership (and that includes its political, policy and regulatory dimensions) can make or break the likelihood of whistleblowing, with or without further duties to report wrongdoing being imposed on professionals. Leadership (its style, culture and manner that are imprinted throughout the organization), and organizational culture, are interdependent, and – for better or for worse – overwhelmingly powerful influences on what happens in organizations, and to the whistleblower.
Organizational culture, with its norms, values, beliefs and behaviours is a dynamic, fluid, social construction. At any moment, people act in line with social norms, conventions and expectations (Warren 2003). The dynamics of working in teams – their power relations, group pressures to conform, to fit in, be a good team player – receive passing attention, at best, in a drive to pin blame on ‘someone’, occasionally on ‘something’, when things go wrong. Well-established findings on, for example, bystanders (why do people ignore somebody in pain?), silence (why do people keep quiet in the face of wrongdoing?), punishment (why do otherwise well-adjusted human beings inflict suffering on others when an authority tells them to do so?) and administrative evil (why do people not recognize that the bit part they may play in organizational life may contribute to larger destructive consequences?) receive little explicit attention. What are these saying about the organization’s response to the whistleblower or to the concerns they raise?
In his independent review into creating an open and honest reporting culture in the NHS, Freedom to Speak Up, Robert Francis concluded that there was a need for culture change in the NHS (Francis 2015). Francis disaggregated various domains of culture as follows. Safety was first; then a culture of raising concerns; one free from bullying; a culture with visible leadership and one of valuing staff; and finally, a culture of reflective practice. This book upends that order; it puts reflective practice first. Without that, we cannot realize the others. Without reflective practice that fronts ethical and moral action (to provide best possible care and to speak out about shortcomings), we cannot ensure patient and user safety. There can be little value to visible leadership unless it reflects, models, expects, lives and breathes ethical health or social care. Without reflection – going beyond the superficial – we will not understand, still less tackle, bullying, the abuse of power, scapegoating and the other mucky stuff that whistleblowing throws up. Without reflection – staring out some some blunt truths about how relationships of power, authority and obedience play out in organizational life – any chance of realizing a brave new world where people speak out as a matter of routine about shortcomings of health and care will remain remote.
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
