When reputation rules: what the Post Office scandal and the Lucy Letby case can tell social work

There was one particular factor, or the fear of it, at the heart of two recent cases that have shocked the nation.

In both instances, senior managers failed to deal appropriately or effectively with known serious problems in their agencies due to concerns about ‘reputational damage’, avoiding dealing with issues raised by staff that affected the least powerful or influential people in the situation.

The Post Office

There was a huge miscarriage of justice in the way the Post Office dealt with sub postmasters over the faulty Horizon Post Office accounting system.

Executives deliberately covered up known problems with a Fujitsu computer system, but chose to pressurise sub-postmasters, many of whom went on to be wrongly convicted, all the time knowing that the system was faulty.

This ongoing and disturbing case highlights how organisations can try to cover up faults and deny proper investigation into possible problems to protect themselves.

The case of Lucy Letby

The former nurse (now struck off the NMC register) was found to have murdered seven infants and attempted to murder six others at Chester Hospital between  2015 and 2016.

She was the focus of suspicion by other staff due to inexplicable collapses and infant deaths commencing shortly after she started to work in the hospital's intensive care unit. Concerns were raised with management at several points, including by the unit's consultants, but these were ignored or given short shrift by the trust’s executives. 

The lack of investigation raises the issue of how senior management should be held to account for upholding the ‘reputation’ of the trust, and its own interests, over the safety and protection of service users.

In addition, there has been very little, if any, questioning about why safeguarding procedures were not put into place by the trust when concerns were raised in relation to the high number of child deaths while Letby was on duty. This then relates to what expectations there should have been to hold senior management to account when they had not taken action to properly inquire into such concerns.

This is important to social work in relation to our duty, set out in the professional code, to whistle blow if we believe that there are things happening within an organisation which are dangerous to service users, or if concerns have not been taken seriously or investigated properly by that organisation. In the Letby case, child safeguarding concerns were both ignored and actively discounted without any proper investigation.

Social work guidance

There is established BASW guidance on whistleblowing and a social worker’s duties are set out in Social Work England’s professional standards, which also deal with how fear of bullying if a person tries to raise concerns can conflict with our core values.

Some key areas that social workers have to uphold under the Social Work England Professional Standards include:

• Work within legal and ethical frameworks, using my professional authority and judgement appropriately
• Recognise the risk indicators of different forms of abuse and neglect and their impact on people, their families and their support networks
• I will not abuse, neglect, discriminate, exploit or harm anyone, or condone this by others
• (I will) report allegations of harm and challenge and report exploitation and any dangerous, abusive or discriminatory behaviour or practice
• (I will) raise concerns about organisational wrongdoing and cultures of inappropriate and unsafe practice (whistleblowing)

The importance of inquiries

These duties can be traced back to bravery of Alison Taylor in 1986, a social worker who had evidence that abuse was taking place against young people in residential young people's units in North Wales.

Her concerns were ignored internally. Alison was dismissed for whistleblowing, and was found later by an employment tribunal to have been unfairly dismissed.

Eventually her pressing for an inquiry resulted in eight prosecutions and seven convictions of former care workers, along with the North Wales inquiry’s full recommendations.

Her actions had a large part to play in the creation of the Public Interest Disclosure Act 1998, which sets out to give protection to whistleblowers from victimisation if they raise concerns about malpractice in good faith, as defined by the law.

Another inquiry highlighting such failures concerned the Mid Staffordshire NHS Foundation Trust, with the 2015 Francis Report finding serious errors by managers and staff in a hospital - including social workers - where patients died as result of a culture of covering up mistakes and bad practice that put patients at risk, and where managers bullied staff not to report such errors.

The government-commissioned inquiry documents gave ‘shocking’ accounts of the treatment of whistleblowers.

Sir Francis found that staff who blew the whistle on substandard and dangerous practices were being ignored, bullied or even intimidated in a “climate of fear”.

A third inquiry was written about in 2017 by social worker Bill McKitterick, who he concluded that the professionals involved, including social workers, should have ensured the safeguarding of the people in institutions of care, by reporting concerns above and beyond the culture of denial.

There is a government inquiry currently being undertaken into why Lucy Letby was not stopped earlier, when concerns were raised by professional staff.

In September 2023, the Health Ombudsman called for the public inquiry into Lucy Letby’s crimes to be widened to examine the NHS’s “cover-up culture” over failures in patient safety.

What do know about social workers views and experiences of whistleblowing?

In research into barriers to whistleblowing, an online survey of 327 social workers found that more than half those taking part had witnessed dangerous systems in their workplace but only 15 per cent believed they would have been supported if they had raised concerns. In addition, 40 per cent had witnessed abusive practice, 58 per cent unethical practice, 24 per cent illegal practice, and 65 per cent dangerous practice.

A large number of respondents said whistleblowers in their authority were bullied, ignored, victimised or had their practice called into question. The majority of the respondents said they had reported concerns, but these were not investigated or taken seriously, with 73 per cent saying no effective action had been taken. See also the 2016 account of the problems experienced by one children’s services social worker.

BASW guidance on whistleblowing 

This guidance sets out the rights, protections and responsibilities of social workers in relation to whistleblowing, and how BASW can support members considering whether they need to take action.

Being prepared to whistle blow is one of the practice principles in the BASW Code of Ethics: "Social workers should be prepared to report bad practice using all available channels including complaints procedures and if necessary use public interest disclosure legislation and whistleblowing guidelines...."

What this means is that as a profession, and as individual social workers, we need to consider how we will respond if we are ever in such a situation, where we can get support to report concerns, and how to follow them through.

In addition, we may wish to consider what responsibilities senior managers have as little action seems to have been taken when they have acted in ways which allow abuse to continue.

There are calls from NHS professionals for this to change. A petition in 2023 demanded the creation of a regulatory body to hold NHS managers accountable by requiring them to be registered with a governing body similar to doctors and nurses and held to a set of professional standards.

The government responded in September 2023 saying: “We are considering whether further measures are needed to improve the accountability of senior NHS managers, who have a significant level of responsibility for the quality and safety of NHS treatment and care.”

The response points out that “all NHS organisations already have an obligation to ensure that only individuals who satisfy Fit and Proper Person (FPP) requirements are appointed at a director level, with a standardised reference system regarding background checks for individual directors, effective from 30 September 2023.”

In addition, "the government is currently exploring whether further mechanisms are needed… including the possibility of a disbarring system.”

We may wish to consider arguing the same should be the case for social work and social care organisations.

Brian Littlechild is professor and lead researcher for social work at the University of Hertfordshire