5c to be updated

Reader 5 Professional Ethics Reader

Three main contexts – personal, professional and organizational – social good in the larger society

Personal ethics can be informed – Family values, religion, and conscience

Professional ethics – (revolved from medical profession) ethical stance as code of conduct

Organizational ethics – closely related to organizational culture – ethos

Case study one – a short summary

Robert Francis the QC – produced the last year report Strafford hospital 2005 and 2008

When as many as 1,200 patients died of preventable causes

His second inquiry (fourth into the hospital and trust); he had to untangle the relationship between hospital management, the health authority which it says he had answered and agencies that monitored standards. It says he asked fundamental questions about the long term impact of marketization had on the NHS.  His inquiry is dissection of how the health service works.

The witnesses (senior staff/leadership of different organizations within the NHS and other parties/agencies) will deal largely with local and specific. In the reader 5 it says, ‘we know what went wrong. What has to be established is why it was not stopped’ Why did the whole chain of accountability, given how vast and long it is and the different organisation and authorities involved, as mentioned in the reader 5, fail to realise that so many vulnerable people were at risk? The two health secretaries also needed convince us they didn’t deny a public inquiry out of fear what might be uncovered

The NHS Confederation – 698 auditing standards and 89 different auditing bodies, which suggest regulations maybe part of the problem rather than a solution – a deeper cultural problem. Patients also struggled to get their voices heard since the abolition of community health councils.

Thinking points

At whose door do ethical principles lay - personal professional, organizational, societal? Where do the limits for responsibility lie? Are there any overlaps? Where are there tensions? How would these be resolved? 

At a glance I think it is an example of the ripple effect and the ethical principles lay within all four in some form, although I would have liked, to have had a breakdown of 1,200 patients that died, before laying judgement on the different ethical principles involved and to have a clearer overall picture.

I would like to know if the preventable causes were scattered across the trust or if they lay in a particular illness, age group, area or domain. Had the earlier cases become more like needles in a haystack, so senior leadership or organizations were less likely to pick up on them; did the impact of dropping community health councils where patients could raise their concerns make the needle even less likely to be spotted. Who is responsible for even one preventable death? How does this get flagged up? Do the people within these organisations, which do audits, have the necessary skills?  Is this about training as well as ethical principles?  Because of the vast amount of different organisations involved did they think one of the other organizations would be dealing with it? Were the deaths indirectly overlooked without knowing? What were the pressures, wellbeing and fatigue of the frontline staff? What could be done to prevent this from happening? What could we learn from it?

Mistakes are often made because this is how we learn, but in a hospital mistakes have severe consequences just like in some child cruelty cases that have been reported on the news.  This does make me think of the red beams within a practice and whose job is it, as I mentioned very briefly on my blog in module one. When should some of the red beams in a practice become more of an orange/amber beam and have a traffic light approach?   Allowing for controlled flexibility of ethical principles and also for different skills, experience and knowledge within a practice to be accessed and used, but not exploited and that includes both parties; also allowing for an element of creativity to be spread within a practice to improve overall performance.

In addition if I go back to the case and compare elements of it to my practice, if I consider a child who may be underachieving or may not be making a particular level for their age. This could either be flagged up by the Teacher, Teacher Assistant/Learning Support Assistant or parent; this would lead to the SENCO getting involved and possibly other organizations and people. This would also be picked up after the teacher had logged/recorded their attainment levels on a database, as it would become a different colour, making it easier for it to be seen by senior members, Ofsted etc… Other factors may also come into play such as illness, disability etc… so all of the ethical principles come into play in some form, although the person at the top may have more control of the funding to allow for more resources or support to be given.

History of ethics - to be continued...