Summary

Management is essentially a practical discipline that is concerned with resolving problems and making decisions about the use of resources. The common perception is that of a concern with questions of getting things done in line with the government policy of the day. However, this is only part of the story. In the increasingly complex world of health and social care, management is also concerned with questions of value and judgement. In the real world managers have to deal with conflicting demands from communities, patients/clients and a range of organisations in the local health and social care system. Contemporary management of health and social care requires a framework within which to reach decisions that are both ethically justified and practically workable. The challenge is to think ethically and to work practically.

Introduction

Whereas ethics has attracted great interest in the context of the caring professions, it is not necessarily the first thing to come to mind whenever the management arrangements for health and social care are under discussion. On the contrary, the common perception is one of people who are at best public servants and who are at worst faceless bureaucrats who merely carry out the wishes of their political masters. A fairly typical contemporary view is that, when all is said and done, managers tend to keep their heads down and deliver what their political masters expect of them. ‘Delivery’ is seen as more important than independent thought and reflection.

But is it all as simple and as negative as that? This chapter suggests that perhaps it is not, and seeks to explore how and why there is plenty of scope for ethical reasoning in management contexts. In fact it does not take too much searching to find real conflicts and choices in management contexts. For example, should managers always favour cost considerations over rights? Should managers always respect confidentiality at the expense of openness? Should managers always be obedient and implement centrally driven policy even when they have strong evidence based on years of experience that it would fail? Or should they follow their conscience as doctors or social workers might do? These are real ethical dilemmas and contemporary managers are facing them in the real world.