The Gosport Memorial Scandal And Starbucks' Tax Avoidance: Ethical Issues And Rebuilding Of Reputation Essay.

In October 2012, Reuters news agency published a special report investigating major tax avoidance by Starbucks in the UK. The investigation was prompted by the company’s practice of telling those who invest in it that the business is profitable, while claiming that they are making losses in their financial reporting to the tax authorities. Since the company opened its first UK branch in 1998, it had earned more than £3 billion in sales of coffee.

Yet, during these first 14 years of business, it paid only £8.6 million in taxes. In the three years leading up to the Reuters investigation, Starbucks did not report any profit and therefore paid no income tax on sales amounting to £1.2 billion. In contrast, a company, such as KFC, who achieved similar revenue of £1.1 billion, paid income tax of £36 million. At the same time, transcripts of investor phone calls over 12 years revealed that officials from the corporation regularly referred to their business as “profitable”.

Knowledge and understanding of relevant research relating to ethical issues pertinent to prescribed case studies as well as analysing and understanding the implications of these issues.

• Ability to independently manage learning resources, demonstrate command of Harvard referencing, structure a report according to academic conventions and express ideas accurately while maintaining academic style.

To what extent has the situation described in the case study damaged the reputation of the organisation? What can the organisation do to rebuild their reputation?

Starbucks' tax avoidance practices in the UK

In the 1990s, 456 elderly patients in Gosport War Memorial Hospital lost their lives because of taking lethal doses of opioid drugs which they didn’t need in the first place. An investigation was conducted into these deaths and the findings were that 456 patients died wrongfully after being given opioid medication prescribed by Dr. Jane Barton (Boseley 2018). An independent panel found that Dr. Barton had routinely overprescribed opioids and most of the doctors working in the hospital were aware of this but they didn’t report her or try to intervene. Infact many healthcare staff knew about the malpractice and even collaborated in administering lethal doses of opioid medication (Brown & Calver 2018).

In 1991, some senior nurses took the matter to the Royal College of Nursing after they noticed diamorphine, medically known as heroin, was being administered to patients who had no pre-existing pain (Boseley 2018). Diamorphine was usually given to patients with severe pain and those in palliative care. The medication was administered through a syringe driver, which is a small infusion pump that administers small amounts of medication, without adjusting the doses for each patient (Brown & Calver 2018).

The nurses were warned by the college not to take further action with their concerns which they did and the matter was forgotten until 20 years later when it was investigated. Dr. Barton faced disciplinary action in 2009 before the General Medical Council (GMC) where she was found guilty of medical malpractice. Despite this guilty verdict, she was allowed to keep her practice license with heavy restrictions and conditions. A year later she retired from practicing medicine (Boseley 2018).

The points that will be looked at in the analysis include customers or patients, how the incident affected the healthcare industry and public relations/media coverage of the scandal. As mentioned earlier, 456 patients lost their lives because of being given lethal doses of opioid medication. These deaths were covered up for a period of over twenty years denying the families who lost their loved ones any justice. When the scandal was brought to light, there was anxiety and fear not only from the general public but also the medical fraternity. According to a British Journal of General Practice (BJGP) article, the Gosport scandal brought up concerns from doctors and the public about the use of opioids as an end-of-life treatment (O’Shea 2018).

The general public makes up the main clientele of any healthcare system around the world. Recently, there has been declining public trust in healthcare which according to Ward et al. (2015) is caused by inequitable healthcare resources and medical scandals that are high-profile such as Gosport. They also noted that many of these medical scandals were happening in both the UK and the US. As a result, the public’s trust was affected significantly and many lacked faith in their GPs, nurses, physiotherapists and other hospital staff (Ward et al. 2015).

The Gosport Memorial Scandal

Public and patient trust in the UK’s health system has been negatively affected by medical malpractice or incompetence scandals ever since the 1990s. Public attitudes have changed towards healthcare professionals as a result of these scandals which have also affected trust in the health system (Calnan & Rowe 2006, p.378). Trust as a concept in healthcare is important because it allows patients to have confidence in the knowledge and skills of the doctors and nurses taking care of them as well as the knowledge that they are always acting in their best interests. The vulnerability of being ill also leads to trust within healthcare settings because the patient believes that the doctor is always acting in their best interest and they know the best course of treatment for their illness (Calnan & Rowe 2006, p.377).

In the case of Gosport, the patients in the hospital were admitted for various diseases; some were end-of-life, others surgery and rehabilitation and others were for minor conditions. Both the patients and their families put their trust in the doctors and nurses to act in their interests and provide the best possible care (Brown & Calver 2018). The nurses working in the hospital had a duty of care to their patients by challenging Dr. Barton’s actions especially when they found out the drugs were harmful to their patients. The findings of an investigative report carried after the scandal was publicized showed that these nurses provided suboptimal healthcare to their patients and they lacked professional accountability for their actions (Boseley 2018).

The patients and their families were failed by the healthcare system for 20 years when inquiries and investigations into the deaths of their loved ones failed to uncover the truth of what happened. Other healthcare organizations, the police and the General Medical Council were criticized for how they handled the scandal with many seeing it as a wider cover up of what happened in the hospital (Boseley 2018). Such revelations are more than likely to erode the public’s trust in Gosport Memorial, the NHS, the police and judicial system, the Medical Council as well as all the other hospitals within the NHS.

The second point to be analyzed is how the scandal affected the health industry by focusing on doctors, nurses and pharmacists. The findings from the Gosport Independent Panel report of 20^th June 2018 found that there was a culture of shortening patients lives, there was institutionalized prescribing and administering of lethal opioid doses to patients who were powerless and unable to voice their concerns (Underhill 2018), when relatives of the patients tried to complain they were immediately shut down by those in authority. The management of the hospital, the nursing council, the General Medical Council, the judicial system, local leaders and other healthcare organizations also failed to act on these concerns and prevent all those deaths. A section in the report highlighted that the doctors and nurses were giving opioids to patients as part of end of life care which was unnecessary because most of the patients who died were admitted for minor conditions (Underhill 2018).

Impact on reputation and public trust

The health secretary, Jeremy Hunt, noted that the Gosport scandal showed there was a culture of blame within the NHS which made it hard for healthcare staff to raise alarms about medical malpractices (Weaver 2018). The secretary further observed that the process of whistle blowing for doctors and nurses was hard because they feared litigation and going in front of the General Medical Council or the Nursing Council. Others feared losing their jobs if they raised concerns about patient safety at their workplace (Weaver 2018).

The report also made note of the fact that the Portsmouth Hospitals NHS Trust drugs committee and pharmacists did nothing to investigate or challenge the prescribing activities within Gosport over the years (Andalo 2018). A consultant pharmacist, Nina Barnett, believed that a lack of clinical pharmacy practice and guidelines contributed to the prescription of the opioid drugs. These guidelines and practice came up later with the introduction of the Internet making them more easily available. After the report was released, the Guild of Hospital Pharmacists made it clear that it would support its members in the event a similar incident arose where patient safety was being put at risk (Andalo 2018).

The third point to be analyzed is public relations and media coverage of the scandal. The Gosport Independent Panel report found that the senior management at Gosport Memorial and other public sector organizations involved placed more emphasis on safeguarding their reputations at the expense of patient safety (Owen 2018). The report concluded that individuals within organizations had a tendency to handle serious allegations in a manner that affected the organization’s reputation negatively. When news of the scandal broke out, no press release or statement was realized by the hospital explaining the situation. In essence, Gosport management together with the NHS failed to adequately handle the public relations nightmare brought about an expose into the 456 deaths of patients in the hospital (Owen 2018).

The first newspaper to break the scandal at Gosport Memorial was a Portsmouth daily newspaper known as The News in April of 2001. The newspaper report covered a police investigation into the killing of one of the hospitals patients after her daughter raised some concerns of how she was being treated (Linford 2018). After this initial story was published, more relatives of victims in the hospital came forward with their stories and the scandal became more exposed. The story also emboldened people working within the hospital to come forward and shed more light on how the deaths happened (Linford 2018).

Ethical issues in both cases

The newspaper continued to cover the story as more families continued to come forward and more details emerged about the scandal. This coverage created a growing demand within the public for an independent inquiry that would carry out an investigation (Forsdick 2018). The coverage showed the importance of media in uncovering activities that are detrimental to society. The role of the media is much more apparent when it comes to transgressions within organizations that later become full-blown scandals. When these transgressions are exposed, the involvement of the media transforms the local event that was confined to a small group to one that attracts a large audience (Palmer, Smith-Crowe & Greenwood 2016, p.436). The media therefore played a vital role in exposing the malpractices at Gosport Memorial.

Conclusion

The focus of this assignment was on a case study based on Gosport Memorial Hospital where 456 patients died because of taking opioid medication that shortened their lives. While the patient’s families got justice in the end, this scandal brought to light the ineffectiveness of the UK health system in addressing patient safety concerns. So how can Gosport Memorial fix its reputation after this? It can lay off all senior managers and board members of the hospital for failing to act on the complaints brought against Dr. Barton. Secondly, all the senior consultants and nurses who administered the opioids should also be investigated and have their practice licenses revoked. Thirdly, the hospital should pay damages for the wrongful deaths of the 456 patients to their families and issue a statement of apology for their gross negligence. By doing this, they are accepting liability for the deaths and taking responsibility for their actions.

Hospital boards should have a high accountability for patient safety and quality care that is being delivered within their hospital. They have a duty to oversee patient safety and address any concerns or complaints that might arise. They are also tasked with shaping the organizational culture and developing systems for the management of the organization (Millar et al. 2013). However many boards are more focused on the financial performance of an organization than on patient safety and quality of care being delivered. The hospital governing board should be focused more on improving service delivery and the quality care being offered within the hospital. They should also adequately investigate and address any serious complaints raised by the patients, their families and staff about safety concerns (Reinarz & Wynter 2015).

Strategies for rebuilding reputation

Another recommendation is that employees in the hospital should have the confidence of coming forward with their concerns without any fear of reprisals. The nurses who went forward with their concerns about the wrongful use of opioids were warned by their nursing board not to take the issue any further (Wilton 2013). If they had the backing and support of the hospitals management regarding their concerns, then they could have pursued this matter further and fought for their patient’s safety.

 A new recommendation by the NHS in addressing recent healthcare scandals in the UK health system requires that all healthcare institutions should have a charter that promotes openness and transparency in the workplace. This charter is meant to give staff an idea of what the expectations are in the event they witness medical malpractices, patient safety concerns or errors in their place of work (Glasper 2016, p.411). If this charter existed in Gosport Memorial Hospital, then the nurses who voiced their concerns would have had more guidance on what steps to take to ensure their concerns were investigated and acted on.

References

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Boseley, S 2018, ‘Gosport hospital: more than 450 patients died due to opioid rugs policy,’ The Guardian, 20 June, viewed 5 December 2018, <https://www.theguardian.com/society/2018/jun/20/gosport-war-memorial-hospital-opioid-drugs-policy-inquiry>

Brown, D & Calver, T 2018, ‘Gosport hospital deaths: the numbers behind the scandal,’ BBC News, 29 June, viewed 5 December 2018, <https://www.bbc.com/news/uk-england-44574899>

Canan, M & Rowe, R 2006, ‘Trust in healthcare organizations,’ Journal of Health Organization and Management, vol. 20, no. 5, pp. 347-417, viewed 5 December 2018, <https://books.google.co.ke/books?id=SvWjUtinmGgC&pg=PT34&dq=how+healthcare+scandals+affect+patients&hl=en&sa=X&ved=0ahUKEwiDxIzW1ojfAhXCzoUKHcYbDxwQ6AEIPTAE#v=onepage&q=how%20healthcare%20scandals%20affect%20patients&f=fale>

Forsdick, S 2018, ‘Portsmouth daily The News praised by panel for coverage of Gosport hospital deaths scandal and championinh families,’ Press Gazette, 21 June, viewed 6 December 2018, <https://www.pressgazette.co.uk/portsmouth-daily-the-news-praised-by-panel-for-coverage-of-gosport-hospital-deaths-scandal-and-championing-families/>

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O’Shea, D 2018, ‘How will the Gosport scandal affects GPs?’ UK Professional News, 18 July, viewed 5 December 2018, <https://www.univadis.co.uk/viewarticle/how-will-the-gosport-scandal-affect-gps-617158>

Owen, J 2018, Reputation management, rather than conspiracy, blamed for Gosport failings, viewed 6 December 2018, <https://www.prweek.com/article/1485890/reputation-management-rather-conspiracy-blamed-gosport-failings>

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