They didn’t teach ethics on my MBA as they didn’t think it was necessary. We were all from the public sector and in those days there were no six figure salaries, no performance bonuses and no lucrative contracts to be negotiated with the private sector.
The only ethical question was: “Is it ok to accept a bottle of whisky at Christmas from the external trainer?”
‘Senior managers lose sight of the aim of improving services and instead become obsessed with improving the statistical returns’
League tables, performance indicators and star ratings were all in their infancy. We had audits and inspections and we wanted to show our departments in the best possible light. This meant briefings with those to be visited or interviewed and providing a pre-inspection report that highlighted out success but also recognised areas for improvement.
Maybe we weren’t more ethical in those days; it was just that we weren’t put in temptations way, there wasn’t the same pressure to deliver, success wasn’t measured in numbers and we didn’t have much to do with the private sector, we certainly never imagined doing multimillion-pound outsourcing deals with them.
Fiddle the figures
Just as big business finds ways of reducing the tax bill, the public sector finds ways of include favourable statistics and exclude unfavourable ones. We have whistleblowers telling us that some multinationals doing big business in this country don’t pay any tax. We have whistleblowers telling us how police chiefs manipulate the crime figures simple by not recording some reports as a crime. Hospitals come up with ways of cutting the waiting list without actually improving the service and ambulance services finds ways of disguising the true extent of increasing response times.
The pressure to achieve continuous improvement, the pressure to set overambitious performance targets, the pressure to cut budgets, the ease with which we can now dispose of those who don’t deliver − no wonder fiddling the figures isn’t considered an ethical issue, just a case of presenting the statistics in the most favourable way.
It’s an unintended consequences of introducing a performance culture. Senior managers lose sight of the aim of improving services and instead become obsessed with improving the statistical returns.
Now we have gone beyond simple adopting the private sectors focus on the numbers to other business sector concepts of “competition” and “price”. Competition in the public sector may have been intended to improve services and increase efficiency.
‘The more we make health and social care a business, the more it throws up new ethical issues’
An unintended consequence, when coupled with a climate of public sector austerity, has been the pursuit of the cheapest, even if this means doing business with organisations that pay below the minimum wage, operate zero-hours contracts, often refuse to recognise trade unions and generally exploit their staff.
When the public sector was the direct provider of such services it was an ethical principle to be a model employer, but in becoming a commissioner rather than a provider of services we have dropped the ethical commitment.
The more we make health and social care a business, the more it throws up new ethical issues. So we must hope that 2014 is the year when ethical leadership returns to the NHS.