Organisational ethics: A solution to the challenges of markets in healthcare?

The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012 introduced extensive ‘market-style’ reforms to the NHS, and part of these was to encourage private and third sector providers to deliver NHS services. The changing healthcare environment in the English NHS, with new configurations of organisational types providing healthcare (such as commercial companies, social enterprises and charities) can create new ethical dilemmas, issues and problems. It will be argued that this sharpens the need for attention to be paid to the ethical operation of healthcare organisations themselves. The key question is how should this be achieved? One solution is to address ethics at an organisational level. This chapter will consider whether organisational ethics programmes could be developed in the UK to address some of the possible ethical issues raised by this new healthcare environment. I will advance a critical analysis of the use of organisational ethics, drawing on critiques of applied ethics such as Illich and Epstein (2018) in this volume, considering whether it is a conciliatory or emancipatory development and if it can be used to challenge changing conceptions of the role of the NHS.