We all avoid asking difficult questions because we might not want to hear the answer. This could be because it is a threat to us or because we might have to confront ourselves or others about their behaviour. Reflection can lead you to difficult questions which are hard to avoid. In this chapter we will explore how reflection can help you to make sure you ask the right difficult question, using safeguarding adults or children and whistle blowing as examples. Through studying this chapter and engaging in the exercises, you will be able to:
• recognize areas of practice where challenging questions may need to be asked
• analyse factors for effective management of concerns at work
• apply reflective practice to the safe management of difficult situations
Moving difficult situations forward is one of the key reasons that we identify for engaging in reflection. In chapter 7, we explored the ways in which reflective practice can help when you are focusing on issues that arise in your own practice. Reflection can help you to challenge and improve your practice. Your reflection may show you that you have gaps in your professional knowledge and skills which can be easily rectified. What may be much harder is the realization that you have identified poor practice or a problem in your workplace or with a colleague, or when you are confronting a particularly difficult problem in your own work. This may be obvious to you as soon as you start to think it through, or emerge as you look at the assumptions behind policy decisions through use of a critical reflection model (Fook & Gardner, 2007; Smith, 2011).
You may have a professional and possibly a legal responsibility to report something that is concerning you in an appropriate manner. These scenarios call for a degree of courage and the sort of professional attributes we introduced in chapter 1 (Banks & Gallagher, 2009). This may be because taking action threatens your relationships with people you are responsible for or people with whom you work, and may even threaten your employment.
There are times in your working life when nothing is obviously wrong, work is getting done, all of the things you can measure and record add up, but there’s a feeling that something is not right. The niggle might not be there all the time but it keeps coming back. You can use reflective practice to play the detective. We are going to use two examples to explore an issue of safeguarding and whistle blowing, respectively.
Safeguarding
A concerned neighbour rings you to say that they are worried because Brian, a vulnerable adult, has been seen out without a winter coat on a very cold day. You call to see him. When you go to visit him, things are different from when you last met. He says there is no tea or coffee to offer you, his hair hasn’t been cut and he hasn’t done any Christmas shopping. Normally, Brian copes well with the help of a part-time carer. He loves offering visitors a drink and likes to be smart. Christmas is his favourite time of year.
You think back to a year ago. What’s different? He seems not to have any money. You start to ask him questions. He really likes his new carer and tells you that his carer has started taking money out of the bank for him and doing the shopping so he doesn’t have to go out in the cold. When you ask him about the tea and coffee, he says that his carer has told him that everything has gone up so much he couldn’t afford them last week. Normally, Brian has been able to manage his money and most of his day-to-day living well.
The trigger for your reflection is a concerned neighbour who has taken the trouble of contacting you as a professional who is responsible for overseeing Brian’s care package. Because someone has alerted you, you now have a professional duty to respond to the situation. In the past, the neighbour has done things for Brian and they are friends; you judge that their concern must be real if they have come to you in your professional capacity.
Put yourself in the shoes of the professional visiting Brian: what are your immediate concerns when you see him? Using the Reflective Timeline (see chapters 2 and 3), your initial thoughts about what makes this moment critical might include:
• someone who prides themselves on their appearance has not had his hair cut
• a sociable person has not been able to offer you a hot drink on a cold day
• someone who loves giving presents has made no preparations for Christmas
Looking back at what you have learnt, your first analysis is that money appears to be going missing. The thing that seems to have changed most is the fact that there is a new carer. This is a challenging situation because, even though you may immediately suspect the carer, there could be other explanations and you have no evidence. Although Brian is a vulnerable adult, you do not have the right to access his bank details and he seems to be happy with the situation.
You are faced with an ethical dilemma, where you must choose between actions, none of which is obviously the best.
 | TIME FOR REFLECTION |
What professional and emotional skills will you need to help you to get to the bottom of this situation?
Write down the questions you think you would ask.
This is where reflective practice can really help, using Schön’s reflection in action (Schön, 1991) to think on your feet, or the ‘in-the-moment’ stage of the Reflective Timeline, where you capture immediate thoughts and feelings.
Safeguarding practice and professional responsibility vary between nations so knowing your own area and limitations will be important. Everyone has a role to play: social workers in the UK, for example, have specific responsibilities (Mantell & Scragg, 2011), but reporting concerns is everyone’s business. You will need to be using all of your professional knowledge: skilled communication and detailed understanding about what, in your professional sphere, to look for.
 | SEARCH AND EXPLORE |
Safeguarding practice varies greatly across disciplines and is influenced by national laws. In the UK, searching for the Children Act may be a starting point, or look for the laws regarding vulnerable adults. Government reports on high-profile cases offer insights into best practice in this stressful and complex practice area.
Possible conclusions
Perhaps the carer avoids meeting you. She has Brian’s pin number and his card. You may want Brian to ring the bank and the police, but he may be very upset about the idea and believe the best about his carer. If the carer has been stealing the money, she realizes that the game is up and disappears. The account number is changed and Brian realizes that he was too trusting.
However, there might be a more innocent explanation. When you finally get to speak to the carer, you discover that Brian has put down a deposit on a holiday and there has been a temporary cash-flow problem. He left his coat at the travel agent and he couldn’t remember where it was. They will collect it when they go to town to do some Christmas shopping and get Brian’s hair cut with this month’s money.
Cases where you suspect someone who is vulnerable is in need of safeguarding are always difficult. You need to be very careful and well prepared with your challenge, which might lead to the investigation of another professional or a family member. Getting it wrong may lead to a victim being left in a bad situation, or to someone who should be investigated being left in a position of power. Getting it right might save a life.
Recognizing that you are in a critical situation, analysing the issues and taking your learning forward will help you to move on and to become a confident reflective practitioner.
Whistle blowing
‘Not again!’ you think, as you walk towards Mary’s hospital room. This is the third time that you have needed to come to see Mary and found the antibacterial handwash is missing. You work your way back through the department until you find a handwash that is not empty, clean your hands and return to her bedside, ten minutes wasted.
The previous week you attended the departmental meeting and heard of the changes that are being made to local budgets and to targets. You mentioned the handwash problem and several colleagues offered further stories about shortages of this and other products. Your concerns were noted by the manager.
As you leave, you begin to reflect on your day. You are conscious of feelings of frustration and not being able to understand why basic safety measures are missing.
 | TIME FOR REFLECTION |
Stop reading for a moment and reflect on this scenario. You might want to use the ‘What? So what? Now what?’ cues from chapter 2 (Driscoll, 2000).
Do you recognize a scenario like this? Is it familiar? Can you recount a similar story? We would be surprised if you have never been in a situation like this and cannot relate to the frustrations of working with limited resources, or of your concerns seeming not to be listened to or acted upon.
What? You felt frustrated and angry. You had to waste time that you could have spent more effectively. You happened to be conscientious, and would not have approached Mary without cleaning your hands, but would everyone bother?
What would have been the consequence of not washing your hands? How many other people might you have had contact with? How many opportunities would there have been to pass infection from one area of the building to another?
Now what? You did clean your hands. You also previously reported the problem at a meeting, and ensured that someone in authority was informed.
Is that it? Is that as far as your responsibility goes?
Key information: what counts as whistle blowing?
We often associate whistle blowing with high-profile cases in which huge sums of money are involved, the public are at grave risk or lives are lost that could be saved. However, the small things, such as a lack of day-to-day resources, like the handwash in our example, also fit this description.
 | SEARCH AND EXPLORE |
There are many high-profile cases of whistle blowing, in health care, environmental situations and the world of finance. You will find many general examples if you search for ‘whistle blowing’ and add your country’s initials. And, for the UK, look up ‘the Francis Report’, which remains high-profile.
‘Whistle blowing’ has become an internationally recognized phrase that usually refers to situations in which someone who is employed in an organization discloses something that is wrong to a person who has the power within the organization to do something about it (Miceli & Near, 2002; Skivenes & Trygstad, 2010). At the more routine end of this definition, it could include anything from day-to-day reporting of shortages, to accidents or near-misses. For other authors, the definition is narrower – for example, Lewis restricts it to just where serious wrongdoing is reported publicly (Lewis, 2001).
Skivenes and Trygstad offer a useful breakdown of the various stages of reporting issues, from routine through to extraordinary:
Normal activity is defined as everyday discussions about issues and perceived wrongdoing, where problems are discussed, and usually resolved at a local level. Day-to-day discussions and team meetings might be an example of this.
‘Weak’ whistle-blowing activity is defined as the reporting of concerns directly to someone in the organization who has the power to do something about it. This might be through a formal meeting where concerns are recorded. Many organizations have ‘reporting concerns’ or ‘escalating concerns’ policies to direct employees.
‘Strong’ whistle-blowing activity is where the reporting of concerns is taken a step further. Perhaps the person reporting concerns can see that no action has been taken, or that the very people who are doing wrong are the people they should report to. Some whistle-blowing policies will direct employees to a more senior person they can contact; in other cases, the person reporting may decide to contact directly the most senior or powerful person that they can.
External whistle blowing is where the person reporting decides to tell someone outside their organization. Again, this may be because they have tried all internal channels and do not believe the issue has been resolved, or because they believe the most senior management of the organization is unable or unwilling to change the situation.
(Adapted from Skivenes & Trygstad, 2010, p. 1078)
 | SEARCH AND EXPLORE |
Why is it such a big deal?
This book is aimed at people from health and social care professions and we might think that all of the organizations we work for have the best interests of the public at heart, so whistle blowing should never be needed. A cursory look at newspaper headlines and recent history shows that this, strangely, is not the case. In the UK, high death rates for paediatric cardiac surgery continued for many years after an anaesthetist, Dr Stephen Bolsin, repeatedly called for reforms, and in the tragic case of ‘Baby P’ many opportunities to realize something was very wrong were missed, only to be exposed after the child died. The Francis Report (HMSO, 2013) has shown that, several years after both of the cases above were exposed, the same mistakes are happening. The prevalence of such cases, worldwide, shows that it is often ordinary professionals working in organizations who have to go to extraordinary lengths to get their voice heard to protect the people they care about.
Whistle blowing is a dilemma for professional people and a situation in which reflective practice can be crucial for several reasons:
• Your Code of Conduct will include a duty of confidentiality respecting the privacy of a person you are responsible for. How do you respect this when you report something that exposes their personal details?
• Your Code will include a duty of care: that you do everything in your power to ensure the safety and wellbeing of those you are responsible for. You will also be expected to work as a team, and show loyalty and support for your colleagues. How can you do both if a colleague is responsible for the wrongdoing? Which do you choose?
• You are likely to have contractual duties; there may be a gagging clause on your contract that prevents you from talking to anyone outside the organization about its affairs. However, your professional Code will require you to report unsafe practice. How do you do the right thing and keep your job?
What factors affect whistle blowing?
Miceli and Near (2002) (see figure 8.1) suggest five factors are important in understanding whistle blowing.
Figure 8.1 Factors affecting whistle blowing (adapted from Miceli & Near, 2002)
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