First, my speech representing social workers in Parliament:
not as an end in itself;
not out of attention seeking;
not out of bloodymindedness.
BUT, as permission to make waves to wash away malpractice and abuse.
The freedom to speak and the right to be heard – without censure – without being pilloried – without threat to one’s job. The freedom to speak – with honesty – with care – with concern for the welfare of the individual – with concern for human rights – with concern for professional principles. And with the professional blessings of colleagues and with the support of the organisation.
The foundations are there. The British Association of Social Workers currently requires its members to recognise a professional Code of Ethics and Practice. Part of that Code says: “Concerned with the enhancement of human well-being, social work attempts to relieve and prevent hardship and suffering.” This responsibility includes: “The right and duty to bring to the attention of those in power, and of the general public, ways in which the activities of government, society or agencies create or contribute to hardship and suffering or militate against their relief.”
The Central Council for Education and Training in Social Work states in its regulations for social work's main qualification that: “Qualifying social workers should have a commitment to the right to protection of those at risk of abuse and exploitation and violence...” The same body in its brand new competences for Approved Social Worker training requires its trainees to: “Demonstrate the ability to protect the rights and dignity of serviced users and to advocate as appropriate on their behalf.”
While these statements are not specific to the reporting of abuse in the “whistleblowing” sense, they, and others, do set up a permissive structure for that freedom to speak. More than that, they also require their practitioners to speak out. BUT: Ashworth; Pindown; the north Wales abuse inquiries; Beck - all shout out that ‘speak out’ is not being heard.
The freedom to speak and the right to be heard. It is common knowledge that staff in Ashworth were trying to make themselves heard for years before the inquiry by Louis Blom Cooper was instigated. At least one social worker in north Wales made exhaustive attempts over a long period to bring to notice the alleged abuses in residential child care; attempts that eroded her professional status and eventually led to her losing her livelihood because she tried to practice the aforementioned principles. Something is definitely not working and the evidence, anecdotal and concrete, strongly points to closures of ranks; corporate cover-ups; and organisational collusion with institutional abuse: the kind of institutional degeneracy which finds expression in the “gagging clauses” in some National Health Service Trust employment contracts.
It is useful to look at the social work role in two separate contexts. The first is that, subtleties aside, it is more or less accepted that the social worker has a clear role as an advocate for service user needs and rights and as a highlighter of dysfunction; There are some authorities which remain uncomfortable with this but, as a general rule, it applies.
Very different are the circumstances in which social workers are faced with malpractice and abuse in their own employing organisation. When this happens, all the rules and the bulk of the workplace cultural pressures militate against the freedom to speak - and the right to be heard disappears under a blanket of corporate chauvinism. The conflict engendered crystalises into one of professional responsibility and duty towards the service user; versus accountability to the employer and loyalty to the authority. In this scenario the frank formal sanctions and the subtler matrix of group victimisation render it virtually impossible for social workers to exercise those all important professional principles without extensive risk to their present and future livelihood.
A General Social Services Council which will accredit and register all social workers is just around the corner. This council will have the power to remove from the register social workers who do not practice within Council's code of conduct. Let us hope that the right to be heard and the duty to speak out is addressed by that code.
Mike Cox, 12.11.92.
INTRODUCTION
I am a relative peculiarity in British social work circles – a practising social worker with 23 years' post–qualification experience and that is from choice; choice not to move into a management career after two, maybe three years’ experience in actual. nitty–gritty social work. but to remain doing social work and continuing to develop the skills and knowledge necessary to do social work – a never-ending learning curve. I'll leave you to work out the corollary accompanying the other choice. This then is Accountability in social work from a practitioner perspective.
One more specification: there is a tendency to sometimes see ‘social work’ as synonymous with ‘social services’ – that is, social work under local authority employment. This is inaccurate. In fact, settings where social work is practiced outside local authority employment have always been numerous and with the burgeoning private and independent sectors encouraged by “community care” requirements, these are currently ever increasing. Please be clear then, that although I may mainly use references to social work in social services departments for ease and convenience, the principles apply across the social work spectrum; excepting a particular instance to which I will refer later.
To begin to examine this, I think it is helpful to make some artificial distinctions and I propose 5 sectors, leaving these deliberately without an hierarchy and suggesting that might be one of the tasks of further debate.
The distinctions I make are between:
From my point of view, I think this particularly useful because certainly in social work (and I know in other disciplines), there are often seminal conflicts between those sectors. And, in my opinion, increasing conflict since the formal implementation of policies in the health care services which have a hard commercial pivot; which turn around fiscal consideration and, sometimes, frank financial gain.
Professional accountability: let's start with a look at a clear example from another profession – The Royal College of Nursing’s “Whistleblow” report “Nurses Speak Out” says: “Under the terms of their professional code of conduct nurses can be struck off the professional register for failing to report concerns about standards of care.”
The 14 point United Kingdom Central Council Code of Professional Conduct states:
“Each registered nurse, midwife and health visitor shall act, at all times, in such a manner as to justify public trust and confidence, to uphold and enhance the good standing and reputation of the profession, to serve the interests of society, and above all to safeguard the interests of individual patients and clients.”
In social work, the position is more blurred. The British Association of Social Workers does have a Prolessional Code of Ethics which it requires its members to observe and part of clause 9 of that code says: “The social worker's responsibility for relief and prevention of hardship and suffering is not always fully discharged by direct service to individuals, families and groups. The worker has the right and duty to bring to the attention of those in power, and of the general public, ways in which the activities of government, society or agencies, create or contribute to hardship and suffering or militate against their relief, This code was developed by the members of the Association between 1970 and 1975 with antecedents and derivations from the pre–existing professional social work associations which merged to become BASW – and international social work sources. It has an excellent “provenance,” as Lovejoy would say, but no statutory authority, Furthermore. BASW membership is but a small proportion of those working in social work in this country.
Offsetting this rather weak focus of professional standing in social work – it has been described as ‘almost a profession’ – are some statements supporting the requirement that employers recognise professional standards and obligations: the Central Training Council for Education and Training in Social Work (CCETSW) has, since the inception of the primary social work qualification, the Diploma in Social Work, firmly included core professional values in the curriculum (paper 30) and in what is considered a penultimate draft of its review of DlPSW, has included as one of the “five core functions of social work”: “Professional Achievement” – “Manage and develop own capacity to achieve professional objectives.” CCETSW's requirements for the training of Approved Social Workers also have competences addressing “core values.”
Looking closer though. what I detect is moves to avoid, perhaps pretending it doesn't exist, that clear acceptance, in the BASW code, of a potentially adversarial relationship between employer and employee – that the employee's professional obligations might require speaking out against the employer’s policy and practice, and that it is O.K., and by doing so professional, and probably public accountability is being observed.
The BASW code goes on to say: “While social workers are accountable to those under whose authority they work, and responsible for the efficient performance of their professional task and for their management of the organisation's resources, these must be balanced against their professional responsibility to their client.” Now, employment law doesn’t appear to explicitly recognise this unless observation of professional ethics and obligations is written in to the contract of employment. I know of no instance of when that has actually happened but if anyone does, it could be useful information.
This is a little shaky – I have very little legal training – but I am led to believe the courts can agree implied terms of contract, and perhaps one of the lawyers present today could clarify whether or not such implicit terms could address the problem of employers disregarding professional obligations. Included in those implicit terms are: “The employer must not, without reasonable and proper cause, conduct him/herself in a manner likely to destroy or seriously damage the relationship of trust and confidence with the worker.” and, “Not to act arbitrarily. capriciously or inequitably” (Employment Law. Kibling & Lewis 1991).
Returning for the moment to the UKCC code (as it is a clearer base having statutory foundation), legal advice to the Manufacturing, Science, and Finance Union in 1993 on potential tensions between the Department of Health Guidance on whistleblowing and the UKCC code, states: “...any ambiguity or inconsistency between any implementation of the Guidance note must be construed so as to comply with the Code of Professional Conduct. Your members could find themselves in a situation whereby complying with their contractual duties they were in breach of their professional obligations to the UKCC. This would put your members at risk for disciplinary action by the UKCC which could include their being struck off the register which could, in turn, lead to their losing their jobs.”
But, even though their position is clearer, if there are nurses being repressed and penalised for fulfilling their professional accountability, What chance do social workers have without a statutory regulatory body?
BASW is not a regulatory body recognised by statute as is the UKCC and the position of a social worker expressing concerns which the employer does not wish to hear; perhaps concerns about possible illtreatment in a residential home which could require expensive action – taking chunks out of an already constricted budget: conflict again with employer accountability – is potentially much more precarious.
“Social work demands from its practitioners standards which are manifestly professional. Yet almost anybody can practise as a social worker. Qualifications for appointment are largely for employers to determine. Employers can control and discipline social workers without regard to any wider responsibilities to the public, and some naturally put their own interests first.” So said Bill Utting, the Chairman of the National Institute for Social Work in January of this year.
In that same article “Almost a Profession” in the BASW journal “Professional Social Work” (and there are good metaphors for the tensions pervading social work in these last few words), he re-affirmed “Ethical practice and behaviour are fundamental to social work.”
The Independent on 9th August reported “The Court of Appeal has ruled that local authorities are not liable.” The House of Lords is to reconsider that decision later this year.
My own perception of this position is (and I could be well off beam; once again, I am not a lawyer) is that there is a move towards a ready recognition of the individual duty of care attaching to the social work practitioner – that he or she has public accountability under common law with concomitant liability – but the local authority social services department, as an organisation, is claiming exemption from public accountability through a common duty of care as it has an overriding accountability through current statute.
On the other hand, sadly, I have often been at odds with fellow practitioners and first line managers close to a practice base whose predominating attitudes seem to be either, ‘I'm just an employee and though I would like to observe and uphold professional values and practice my employer has all the power and I have no choice’, or, ‘I think professional values are a fine ideal but I have prospects of a career in management to consider and if I make waves it will go on my personal file and I will go no further or even lose my job.’
Work with Freedom to Care and the Mental Health Special Interest Group strongly indicates I do not by any means have a monopoly on this kind of experience and firmly believe that the majority of those social workers who have chosen to remain in practice, and who have an active professional commitment, if surveyed, if able to be surveyed – there are barriers to this – would give similar accounts.
And, whilst the legal differences remain – the absence of a statutory regulatory body to establish professional standards recognised by law and the existence of legislation which ignores professional standards these juxtapositions will remain.
But, as well as the phenomenon in social work in particular, of properly skilled and experienced social work practitioners being a significant minority of the workforce – the vast majority being managers: social workers with under three years' post-qualification experience, and a growing sector, about to mushroom under the encouragement of social services management, of workers without social work qualifications, coming to be known as social services or community care operatives.
Part of that minority have no wish to acknowledge professional status and part of that minority – as well as a good proportion of the majority – are frankly frightened of losing their jobs and homes in a national culture which remains antagonistic to a welfare ethos and in organisational cultures which, despite the recent rhetoric about community care and child care legislation and the spotlights on mental health, accelerate in the direction of the commercialisation of other people's misfortunes.
Other people’s misfortunes, as we seem to see increasingly in the press, are too often the products of abuse and malpractice by social workers or people who operate within the healthcare structures. Examination of the media reports alone though, without recourse to whatever formal inquiries have been conducted afterwards, will usually clearly show attempts by individual workers, sometimes over long periods, to express staff concerns about what is going wrong. And yet it is almost invariably those individual workers who are pilloried in the press - not the organisations who, at base, have the real controls over practice.
That duty of care – that public accountability referred to earlier has been exercised – or rather, strenuous attempts to exercise it have been made with those attempting to meet their common law obligations sometimes being seriously penalised for trying. Surely there is a core problem here – some people in key positions are not listening or not hearing.
Or only listening to the clunk of the coin in the county coffers?
What if that bit I was uncertain about is accurate – if the House of Lords upholds the High Court decision; if the duty of care and liability for public accountability is fully recognised in the individual social worker but the local authority, and by extension its management, is held not to have a duty of care. All the onus is then again on the employee and the employee, whilst being fully accountable and liable, has no say, no control, as to how the employer shapes the events. Where on earth do we go from there?
Towards resolving these dilemmas there is something of a consensus in BASW that establishing a General Council for Social Work or Social Services is a priority. The completed groundwork, shelved by the Government at the end of 1992 has at last been creakily acknowledged by John Bowis after our representations around our lobby of Parliament in June of this year and the current state of play is an early day motion laying on the table with the signatures of 77 MPs.
(a) Any instance of malpractice, negligence, or unprofessional behaviour. That is: any situation where the service user is being abused or their rights and dignity are being, or have been, disregarded or over-ruled or where decisions are taken which are clearly not in their interests and put them at risk of abuse, exploitation. oppression or discrimination.
(b) Any matters of concern they may have about social care, health care or education policy and practice issues concerned with the delivery of care to service users or carers in their authority, trust, agency or unit which are detrimental to service users' and carers' interests.
(c) Any circumstances arising to do with the employment environment, employment conditions or employers' practices that could place colleagues at risk.
Every Social Services manager has a duty to ensure that staff are easily able to express their concerns through all levels of management to the employing authority or Trust. Managers must ensure that any staff concerns are dealt with thoroughly and fairly.
Thank you for listening. We look forward to some energetic and fruitful debate both within and without this conference.
This brief history is taken from the 1st edition of the Freedom to Care Handbook, published in January 1998. It is not attributed in the Handbook but I would guess from the detail it is written by Geoff.
Geoff Hunt, in my experience is one of those extraordinary people one is privileged and proud to know. A brilliant academician in ethics, he more or less singlehandedly takes the credit for the existence of Freedom to Care although he would, typically generously, tell you it was a co-operative project. Here are what I believe are his words:
Geoff Hunt resigned from Swansea University in protest over the affair in 1990 and founded a centre for ethics in nursing, midwifery and health visiting at Hammersmith Hospital that year. At this time the NHS was undergoing an onslaught from ‘new managerialism’ and there were many whistleblowing cases. In 1991 Geoff organised the UK's first national conference on whistleblowing, focusing on the NHS, which took place at Nottingham University. Graham Pink, the whistleblowing charge nurse, was one of the speakers. The conference was reported in the 'Health Service Journal, the nursing press and elsewhere. Geolf suggested to Graham that they bring together as many whistlcblowers as they could find to create a support group. The first meeting of the group met at Thames Valley University in early 1992, and went on meeting under the name ‘HealthCare Accountability Network’ Guy Dehn and Marlene Winfield were among those who attended these meetings – before they created the professional legal advice centre Public Concern at Work.
In October 1994 Freedom to Care registered itself as a company limited by guarantee. It began to widen its remit to embrace all workers who were victimised, or were in fear of victimisation, for speaking up in the public interest. Freedom to Care was now beginning to attract publicity in the press and on TV and radio Appearances included World in Action, Horizon, Public Eye, The Money Programme. It obtained a grant from the Joseph Rowntree Reform Trust for the period 1994-96. In 1995 Arnold published Whistleblowing in the Health Service: Accountability, Law & Professional Practice, edited by Geoff Hunt and in 1998 a companion volume, Whistleblowing in the Social Services will appear (My chapter in this is Training for Accountability – My parenthesis). Allan Levy QC and John Hendy QC became patrons of Freedom to Care in 1994, and Austin Mitchell MP became a patron of FTC’s ethics in financial services network in 1997. From 1997 FTC was organised into a number of occupational networks. In late 1997 three networks were operating: caring services (social work, nursing, social care, etc.), financial services, science and technology.
In 1996-7 Freedom to Care supported 23 ex-employees, trainees and current employees of the Anglo–Australian pensions and insurance company Colonial (then Colonial Mutual) in their complaints of training & sales malpractices, regulatory breaches and poor treatment of staff. As a result of FTC's report on the matter Colonial was criticized in the media and brought before the regulatory body. FTC has been asked to consult with the new government on a new regulatory structure for financial services. In 1997 FTC published the evidence of a community doctor that children downwind of a power station in Wales were suffering from asthma as a result of the station's pollution. Largely as a result of FTC’s campaign the station withdrew its application to burn a Venezuelan bitumen called Orimulsion which would have caused more pollution and more disease.A Brief History of Freedom to Care
Freedom to Care was founded by Dr Geoff Hunt, a university lecturer in ethics. He returned from eleven years in Africa in 1987 to a lectureship at Swansea University. In 1989 he raised concerns at the University about academic malpractice He was joined by three other colleagues. All were victimised. There were three internal inquiries and, eventually, two public inquiries - one headed by Sir Peter Swinnerton Dyer and the other by Sir Michael Davies. These inquiries vindicated the whistleblowers. Sir Michael Davies’ Report is published as a book: The Davies Report: The Great Battle in Swansea (Thoemmes Press).
(It was at this point that I was asked to become involved and I joined, representing social work via BASW and widening the brief beyond health and academia, at the second meeting at Hammersmith Hospital – My parenthesis)
In November 1992 Geoff suggested a change of name to Freedom to Care, and the group was launched at the House of Commons with the support of Derek Fatchett MP. Three days later Geoff Hunt was sacked by the health authorities which paid his salary.
As well as those mentioned above I'd also like to pay tribute to other valued friends and colleagues who did much excellent work: