Table Of Content

Care in the Iron Cage This book explores two public sector scandals in the UK, drawing on Max Weber’s thought on ‘the iron cage’ to understand how these cases of patient-neglect in NHS hospitals and failures by police and social workers to address the organised sexual exploitation of young girls occurred. Through examination of the management failures and institutional vulnerabilities, and with attention to the trends of bureaucratisation and rationalisation that characterised both scandals, it reveals the explanatory power of Weber’s thought, developing a theoretical model that updates and extends Weber’s work in light of the cases discussed. The final chapter examines the response to the COVID-19 pandemic and highlights how the focus on a rational techno-medical solution to the pandemic offered by the vaccines together with bureaucratic expansion has created an authoritarian and totalitarian society which represents the ultimate realisation of Weber’s iron cage. Showing that ordinary people, including professionals, are still trapped in the ‘iron cage’, it will appeal to scholars of sociology and social theory, as well as those providing training and working within the caring and service professions of policing, social work and nursing. Rowena Slope is a Senior Lecturer in adult nursing based in the UK. Her clinical experience includes working as an Emergency Nurse in an Emergency Department while her doctorate analysed handover communication between prehospital and hospital receiving staff. Classical and Contemporary Social Theory Classical and Contemporary Social Theory publishes rigorous scholarly work that re-discovers the relevance of social theory for contemporary times, demonstrating the enduring importance of theory for modern social issues. The series covers social theory in a broad sense, inviting contributions on both ‘classical’ and modern theory, thus encompassing sociology, without being confined to a single discipline. As such, work from across the social sciences is welcome, provided that volumes address the social context of particular issues, subjects or figures and offer new understandings of social reality and the contribution of a theorist or school to our under- standing of it. The series considers significant new appraisals of established thinkers or schools, comparative works or contributions that discuss a particular social issue or phenomenon in relation to the work of specific theorists or theoretical approaches. Contributions are welcome that assess broad strands of thought within certain schools or across the work of a number of thinkers, but always with an eye toward contributing to contemporary understandings of social issues and contexts. Series Editor: Stjepan G. Mestrovic, Texas A&M University, USA Titles in this series: Masculinity from the Inside Gender Theory’s Missing Piece Bruce Fleming Care in the Iron Cage A Weberian Analysis of Failings in Care Rowena Slope For more information about this series, please visit: https://www.routledge. com/sociology/series/ASHSER1383 Care in the Iron Cage A Weberian Analysis of Failings in Care Rowena Slope First published 2023 by Routledge 4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 605 Third Avenue, New York, NY 10158 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2023 Rowena Slope The right of Rowena Slope to be identified as author of this work has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Names: Slope, Rowena, author. Title: Care in the iron cage: a Weberian analysis of failings in care / Rowena Slope. Description: Abingdon, Oxon; New York, NY: Routledge, 2023. | Series: Classical and contemporary social theory | Includes bibliographical references and index. Identifiers: LCCN 2022025187 (print) | LCCN 2022025188 (ebook) | ISBN 9781032154084 (hbk) | ISBN 9781032182957 (pbk) | ISBN 9781003253907 (ebk) Subjects: LCSH: Social sciences--Philosophy. | Child sexual abuse-- Great Britain. | Weber, Max, 1864-1920. Classification: LCC H61 .S5875 2023 (print) | LCC H61 (ebook) | DDC 300.1--dc23/eng/20220906 LC record available at https://lccn.loc.gov/2022025187 LC ebook record available at https://lccn.loc.gov/2022025188 ISBN: 9781032154084 (hbk) ISBN: 9781032182957 (pbk) ISBN: 9781003253907 (ebk) DOI: 10.4324/9781003253907 Typeset in Times NR MT Pro by KnowledgeWorks Global Ltd. Contents List of Tables vi Introduction 1 1 Life, Times and Works of Max Weber (1864–1920) 16 2 Relevant Applications of Max Weber’s Work 23 3 New Managerialism at Mid Staffordshire and Rotherham 35 4 Professional Indoctrination 54 5 Regulatory Compromise 71 6 Acts of Violence 84 7 Human Fragility 97 8 Sensory Deprivation 109 9 Going Forward 118 10 Conclusion 131 COVID-19 Afterword 136 References 152 Bibliography 169 Index 172 List of Tables 4.1 Preventing and Dealing with Dual Loyalty 58 9.1 A Summary of Common Factors between Rotherham and Mid Staffordshire, Identifying Possible Improvements 129 A.1 Yellow Card Data by COVID-19 Vaccines and Associated Reactions 143 Introduction Personal and Professional Biography I am a Registered General Nurse with the Nursing and Midwifery Council (NMC) and have worked in a range of clinical settings and higher education in the UK. The inspiration for writing this book came from working as an Emergency Nurse in a National Health Service (NHS) Foundation Trust hospital. At that time, a report had been released concerning poor care and neglect by healthcare professionals in a hospital in Mid Staffordshire, England, which was estimated in media reports to have led to 800–1200 deaths. Upon reading the report, I could relate to the vulnerabilities and hazards faced by patients caught up in these difficult circumstances and wondered how healthcare professionals could have been implicated in treating patients so poorly. At the same time, I recognised the pressures faced by staff trying to deliver care in the context of new managerialism, especially, performance management tasks. These targets were set by central government and were designed to improve patient care and save costs. The most recognisable target was the four-hour target whereby a certain percentage of patients attending an Emergency Department (ED) or Accident and Emergency (A&E) Department (known as the Emergency Room in the USA) had to be seen, treated, discharged or admitted within four hours. Hospitals were incentivised to meet these targets in order to gain the coveted Foundation Trust status and the financial independence that accompanied it whilst hospitals that failed to meet the targets faced financial penalties. The introduction of new managerialism led to unintended consequences as some hospitals cut frontline staff members to unsustainable numbers and huge pressure was brought on frontline healthcare professionals to meet the targets. This produced constant moral dilemmas about who to treat and when, exacerbated by the chronic staff shortages, and the ever clicking clock. I could relate to the suffering of patients and staff caught up in an institutional setting that was not conducive to promoting health and well- being, or the delivery of holistic nursing care, and the acute vulnerability of dementia patients in particular in such institutionalised settings. DOI: 10.4324/9781003253907-1 2 Introduction Hospitals can be a potentially hazardous place for any patient. Every day spent on a hospital ward increases risks associated with muscle atrophy, blood clots, hospital acquired infections, gastrointestinal disruptions, medical and nursing errors, and institutionalisation. Hospital routines disrupt circadian rhythms whilst patient identity and autonomy are eroded by a lack of personal effects and access to individual grooming routines. A variety of environmental hazards and architectural constraints exacerbate a sense of disorientation. These include fixtures, fittings, ward layout, excessive noise and a lack of natural light. Privacy and dignity is constantly challenged by proximity to other beds, thin curtains and revealing hospital gowns. Combining these factors together, hospital wards can be a dehumanising place even with great nursing and medical care. However, the risks associated with admission increase when organisational cultures are focused on targets introduced by new managerialism rather than delivering quality care, defined here as care that is safe, effective, individualised and holistic. A focus on quantitative targets compromises quality care and leaves staff and patients at risk of dehumanisation. Hospitals are essentially hierarchical bureaucratic organisations and when managers far removed from frontline services focus on quantitative outputs then dysfunctional and bullying cultures can emerge. Around the same time as the report into Mid Staffordshire was released, a journalist called Andrew Norfolk published an investigation in the Times newspaper on organised Child Sexual Exploitation (CSE) by criminal gangs in Rotherham, England. Child Sexual Exploitation is defined as: a form of sexual abuse. It occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual. Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology. (HM Government, 2018, p. 107) An independent report was commissioned by Rotherham Metropolitan Borough Council known as the Jay Report (2014) which identified repeated failure by public sector services including the criminal justice system, social services and local councils to disrupt the activities of these gangs or to pro- tect vulnerable young people and their families from sexual exploitation, intimidation and violence. It was estimated that around 1400 children and young people were victims of this organised abuse between 1997 and 2013 (Jay, 2014, p. 1). At first glance, there seems nothing obvious linking patient neglect at Mid Staffordshire and CSE in Rotherham. However, closer examination of Introduction 3 the multitude of reports into these two cases reveals striking similarities in regard of organisational dysfunction and the failure of caring professionals. Victims of CSE faced similar hazards as patients at Mid Staffordshire hospital in relation to dehumanisation, and vulnerability increasing on contact with state institutions. Moreover, a common theme appeared to be new managerialism which was introduced into the public sector by central government in order to make services more efficient and business like. Performance management targets were not just introduced to the NHS but also the police service, Crown Prosecution Service (CPS) (responsible for prosecuting criminal cases in England and Wales) and social services. The result was that these services were primarily focused on meeting quantitative targets over care delivery or public protection. At Rotherham, new managerialism and performance management targets left victims unpro- tected from criminal gangs whilst essentially placing the blame on victims. The impact of new managerialism on organisations, the individuals working for them, and the care and protection that they were tasked with delivering, can be illuminated by the theories of Max Weber, a sociologist, particularly his theories on rationalisation and bureaucracy. Max Weber (1864–1920) is credited as one of the founders of modern day sociology. The original intention of this book was to provide a comparative analysis of Mid Staffordshire and Rotherham inspired by a Weberian approach but it soon became apparent that Weber’s core ideas needed updating to reflect changes brought about by modernity. This book also owes a profound debt of grat- itude to the work of other distinguished sociologists such as Bauman and Ritzer who developed Weber’s work to account for such diverse phenomena as the holocaust and the McDonalds restaurant franchise. The update on Weber’s theories to emerge from this comparative analysis of Mid Staffordshire and Rotherham are based around five themes: Professional Indoctrination; Regulatory Compromise; Acts of Violence; Human Fragility; and Sensory Deprivation. A chapter is devoted to each theme and informed by relevant practical examples. The theoretical update to Weber’s work presented in this book has explanatory value beyond Rotherham and Mid Staffordshire, and can be used to examine the response by governments around the world to the SARS-CoV-2 (COVID-19) pandemic declared by the World Health Organisation (WHO) in March 2020. Since the emergence of this new novel virus in the human population, governments have responded with lockdowns, masks and vaccine mandates based on a limited evidence base but supported by technological organisations and media outlets. Despite an Infection Fatality Rate of less than 0.2% (ONS, 2021) authoritarian actions have become more entrenched leading to increased totalitarian and authoritarian responses. Other casualties have been parliamentary democracy, the rule of law, medical ethics and quality care. Therefore, a supplementary chapter has been included as an afterword to demonstrate the utility of this theoretical update to Weber’s work reflect- ing on these events.