International Whistleblowing Research Network Conference Sarajevo 2015 Dr Angie Ash Angela Ash Associates, UK

… Q of ethics Context counts Ethics in context Angie Ash © 2015

1. Themes from failure 2. Research – care and mistreatment of older people 3. An ethic of care 4. Ethical complicit cultures Angie Ash © 2015

1. Abuse has contexts & cultures 2. Fragmented, marketised systems  the Holy Grail of box-ticking 3. Professional reluctance to challenge (Ash 2011) Angie Ash © 2015

 What dilemmas do social workers & their managers grapple with when dealing with possible abuse of an older person? Angie Ash © 2015

 Hard to engage the NHS  NHS care and older people “I’m waiting for the NHS to re-badge relatives as “partners in care” … (relatives have) to provide so much basic care just to ensure their loved ones get access to adequate hydration during the day” Social worker “… the way in which nurses speak to relatives and patients. I don’t mean niceties. It might be something like ‘I told you to sit down, so sit down and shut up’”. Social worker Angie Ash © 2015

 Resource shortfalls – quality/quantity, people/cash  Dilemmas of resources and care  trade-offs: collapsed home care situation /risk of hospital-acquired infection / marginal quality care home Angie Ash © 2015

 “You’ve got somebody broken down at home, the carer can’t possibly cope anymore, you're going to make a placement, it meets regulatory standards, it’s acceptable, but well … that’s a very real world for people”. Manager  “You calibrate what’s acceptable to what you know … you operate in that real world”. Manager Angie Ash © 2015

 … “the whole place is an abuse” “ … if a person got out of their chair because they were trying to attract the attention of someone … before they (could) say anything they were told to sit down”. Social worker “There’s been all sorts of things down to people being fed slightly roughly or disrespectfully or people not having their teeth in”. Manager Angie Ash © 2015

“… (the investigation) shocked a lot of people. There’s a lot of guilt around these situations. I've talked to nurses who say ‘I did a review there two months ago why didn’t I pick up these things?’. I’ve talked to social workers who say ‘we've known for ten years (the home) is not a very great place but we've placed people there’. There’s a lot of guilt and discomfort around that”. Manager Angie Ash © 2015

“… that atmosphere and that attitude…most people who’ve never been in a nursing home would just be completely shocked by it. The danger for us is that we (get used to it)”. Social worker Angie Ash © 2015

“I don’t think for a minute social workers would actually walk away from a situation they thought was abusive, but I do think if you said to social workers ‘are you content with where people are placed, is this the sort of quality of care you’d want’, then probably the answer is no”. Manager Angie Ash © 2015

 Attentiveness  Responsibility  Competence  Responsiveness (Fisher and Tronto 1990; Tronto 1993) Angie Ash © 2015

Attentiveness  … noticing needs is a primary human task –  “ You can add all the usual money and things like that but I think … strategically it’s about giving it attention” Manager Angie Ash © 2015

Responsibility  comes out of recognising need  is embedded in cultural practices - not rules, obligations, duties Angie Ash © 2015

Competence  “Intending to provide care … but then failing to provide good care, means that in the end the need for care is not met” (Tronto 1993:133) Angie Ash © 2015

Responsiveness  needing care places person in some vulnerability  stay alert to “the possibilities for abuse that arise with vulnerability” (Tronto 1993:133) Angie Ash © 2015

Ethical cultures 1

Angie Ash © 2015 Ethical cultures 2

Angie Ash © 2015 Ethical cultures 3

“All this activity that goes on often doesn’t seem to get to the heart of how people are living and being cared for. (When a report) throws up quite serious concerns about a place we think well hang on a minute, we’ve had contracts with individual people there for a long time … why don’t we have a full picture of what it’s like to live in a place where the people are subject to abuse?” Manager Angie Ash © 2015

Whistleblow or Walk on By? Ethics and cultures of complicity in health and social care Dr Angie Ash angela ash associates PO Box 16 | Usk | NP15 1YB | Wales | UK E: W:

Ash, A (2010). 'Ethics and the Street-level Bureaucrat: Implementing Policy to Protect Elders from Abuse'. Ethics & Social Welfare, 4, 2, Ash, A. (2011). Personalisation and safeguarding. What can we learn from serious case reviews?. Paper given to 'Practical Safeguarding', 16th National Conference of Action on Elder Abuse. Manchester Conference Centre, March. Ash, A (2013). ‘A Cognitive Mask? Camouflaging Dilemmas in Street-Level Policy Implementation to Safeguard Older People from Abuse’. British Journal of Social Work, 43, 1, Ash, A (2014). Safeguarding Older People from Abuse. Bristol: Policy Press. Ash, A (forthcoming). Whistleblowing and Ethics in Health and Social Care. London: Jessica Kingsley. Fisher, B and Tronto, J (1990) 'Toward a Feminist Theory of Caring' In B. Fisher (Ed.), Circles of Care: Work and Identity in Women's Lives (pp ). Albany, NY: SUNY Press. Tronto, J (1993). Moral Boundaries. A Political Argument for an Ethic of Care. New York: Routledge. Angie Ash © 2015