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 the health and social care system, including public policy, the regulation of health and social care and the organizations and services that employ health and social care professionals and others. The chapter maps out what this might mean, and how it might manifest. Its crux is the need for ethical care that, routinely and as a matter of course, is intolerant of poor, marginal or downright dangerous action, and which expects and encourages people to speak out.
Chapter 8 returns to the overwhelming significance of organizational culture, and of those in leadership positions, on the behaviour of people working in it. If an ethic of care is to drive the work of the health and social care system, and the speaking out about shortcomings of care, then it needs clear expression and realization by its leadership. The chapter considers what ‘ethical’ leadership would look like, how it would influence the organizational culture and its responses to whistleblowing. The emotional intelligence of the leader, their awareness of self, others, the culture and climate of the organization and its secrets and silence, are put forward as hallmarks of a leadership style that is well-positioned to deal, ethically, with disclosures a whistleblower makes.
Finally, Chapter 9 summarizes the critical need to understand whistleblowing as a moral act that requires a moral response. If the whistleblower is the messenger, why not listen?
WHAT THE BOOK IS NOT
This is a wake-up book, not a feel-good guide. That these things happen to whistleblowers should alert the reader, not render them mute, inert or silent. Nor is this a whistleblower’s self-help manual, how-to handbook or legal sourcebook. There are good sources of help, and the book’s Postscript on its final pages has a few words to say about these to a prospective whistleblower. These can be summarized: get wise and get prepared.
At some points, the author’s weariness with the myopic policy fixation on delivering targets by any means necessary bleeds through. It would be wrong to read this as a call for targets, standards and the related regulatory apparatus to be junked. Not so. The problem isn’t the targets or standards, but the obsession in hitting them, rather than understanding the point of them – the people, humanity, pain and suffering that lie behind the numbers. The problem is believing that targets, ipso facto, safeguard patients and citizens from harm. The problem is their deracination from an ethic of care and from the affective, human dimensions of competent health and caregiving. You may have been seen within two, four or however many hours the target for attention in Accident and Emergency is that day, but if you have a ruptured spleen and you are sent home with aspirin this (achieved) target says zilch about your health, care or prospects of survival.
There is not a great deal of evidence that training employees on ethics and morality has much resilience beyond the training room. In laying out these limitations, the book is not suggesting such training is worthless but that its application back at work is what counts. All that training has to be given the chance to work – in the workplace. If it’s strangled at birth by a disinterested leadership who want the numbers of people trained but not the outcome, then the impact of this training will be negligible. It won’t change a thing: what happens in the workplace will.
TERMS USED
Health and social care are used mostly as conjoined entities in this book, though the reality of health and social care service planning and provision in the UK is far from that. ‘Health’ is used to refer to regulated public or private healthcare. ‘Social care’ includes statutory or voluntary social work, provision of personal care, support to the person, whether adult or child. Aggregating adult and children’s services in this way is done expeditiously. (In some parts of the UK adult and children’s social services have been separated.) The point of the book is not the organizational structures of health and social care. They shift over time. Its concern is what happens inside those organizational entities when people speak out about wrongdoing. That changes much less.
Whistleblower and person raising concerns, and ‘whistleblowing’ and ‘raising concerns’ are used interchangeably, but legally they are different. The person blowing the
