Guest Post: The Commodity of Care


Please enjoy this guest blog post by Carol Dimon, a UK-based nurse and writer who is a new friend of RNFM Radio.

Poor care is taboo in nursing, yet it has festered like a sore for many years. Within the USA, Australia and the UK, there are historical links to workhouses, where the “non-deserving poor” were harbored. The Protestant work ethic, with its emphasis on individual redemption through work—and individual responsibility of contributing towards society through work—is the prevailing ethos that has affected attitudes toward treatment of the ill, and is still prevalent today.

For example, there were restricted diets or harsh treatment within the workhouses. The mentally ill were flogged, albeit with the declared good intentions to drive out evil spirits.

Yet today we have evidence of patients being locked in a cupboard on a hospital ward, beanbags thrown at residents in a nursing home, falsified records, extremely low staff levels, staff who cannot understand English, unnecessary deaths of patients, and patients ringing the police when they are not being cared for.

This is even more prevalent within the forgotten areas of care for the most vulnerable, such as care homes for the elderly. And in the private sector in the UK, some homes are owned by private equity trusts, which means we do not know who really owns them and who is ultimately responsible. Privatization brings the abdication of government responsibility for care and the thriving of businesses. As Fernandez (2012) concludes, private equity trusts employ less staff and deliver a lower quality of care.

The Commodity of Care

These aspects of healthcare are explored within “The Commodity of Care”, a book I undertook with the help of a co-author. And surprisingly, we are unconnected to any university or nursing organization.

Consider the case of a patient who is deliberately sat on by a heavy care assistant, or a patient who is shouted at by a qualified nurse; these cases involve attitudes, not short staffing, as many would prefer to declare. Short staffing surely causes a different type of poor care—omission of care.

Poor care occurs in many forms, from errors (such as forgetting to write in a care plan) to medication errors (which may result in harm to a patient, or even death), to deliberate physical or verbal abuse. Many cases may be found in the UK, via the NMC website, some in the national press, some in local newspapers, or more on blogs and alternative news sites. In the USA or Australia, there are many cases documented on websites or alternative new sites. ABC Australia is particularly useful. Why, then, do many similar cases remain hidden?

Many would appear to prefer to disbelieve in such cases, especially since they consider there is nothing that can be done. Some believe them to be “one-offs” that are not offenses that occur on a regular basis. Others are guilty or ashamed. Some businesses would rather protect their business and profit margins. Many staff and students are unaware of what to do, or they are afraid to challenge the system.

Politics and the Improvement of Care

Past recommendations to improve care have focused on the patient’s bedside such as team nursing, or other nursing models. Such recommendations did not consider how the dominant political ethos in any society affects standards of nursing care; they attempted to address nursing care as if it existed in a political vacuum.

Politics determine the amount of money allotted to nursing care; the way in which this is spent (private versus public provision); and the nature of those undertaking care. The “cult of self” that has been encouraged in free market economies does not lend itself to developing caring and compassionate attitudes toward others, who are sometimes seen as “less deserving“, if unemployed, or “burdensome to the young“, if old, and needing adequate health funding. Such divisions are crudely exploited by politicians in a neo-liberalistic approach.

The Quality of Staff

What of the staff themselves? The UK, Australia and the US employ a large number of nurses from overseas, and nurses from overseas are cheaper and complain less. Yet fake certificates are very easy to obtain via the Internet, and they may not visibly be recognizable from the real thing. Many blogs and news reports suggest that there are a high number of nurses with fake certificates in all countries. Some staff may recognize such nurses when they are being followed and observed on shift, or if they are questioned about simple procedures. Meanwhile, many trained nurses in all three countries are unable to obtain employment.

My book suggests that fingerprinting may be the only way of ascertaining that the staff member has legally acquired that certificate. Otherwise the whole of nurse education (and other fields) is under question. One wonders if this is the aim, when in all three countries, many newly qualified nurses cannot obtain jobs as nurses within their home country. Many private care homes and hospitals have contracts to maintain a supply of overseas nurses.

What Can Be Done?

So what can be done about all of this? Many argue that we should only talk publicly of good care. This is brushing the problem under the carpet; nor does it protect patients and staff who wish to challenge the system. There are several “independent” campaigns in all three countries, aiming to promote improvements in care or, in the case of the UK, salvage the National Health Service (NHS).

In these countries being discussed, the complaints procedure is questionable. Within the UK, it is more difficult to complain about the private sector than the National Health Service. Yet in any case, when problems reach an ombudsman, the majority are discarded. Ideally, it should not arrive at the need to complain. Many in today’s society are swept along by the need to work or make money or treat one another as a commodity.

Are there any solutions to this huge mosaic of problems?

Politically, hopes may be disappearing since the censorship of Internet communications and publications abounds in many countries, along with tales of dictatorship and a “New World Order”.

Could individuals unite, thus opposing government aims to create disharmony amongst the masses? Could we not try to spread a bit of positivism and harmony as Nurse Keith and others attempt on social media platforms? Or is this disguising reality and thus fooling ourselves? When, eventually, even the private hospitals close due to finances or poor care (Houle and Fleece, 2012) and there is no care available for the poor, what then? Is this inevitable?

We need to unite together and recognize the problems, communicating against all odds in order to inform both our fellow professionals and the public. Meanwhile, we also must support each other and, yes, remember the positive.


Carol says about herself: “Having qualified as a nurse in the UK in 1986, I worked mainly in nursing homes.
Concerned about quality of care, I began campaigning and analyzing possible reasons for poor care over the last 30 years. Whilst I am no longer registered as a nurse, I am available for university lectures, speaking engagements, advice, or assisting student nurses. Presently I work as an independent writer and researcher.” I can be reached via email at

Free updates from Carol are available here:

To read sample chapters of “The Commodity of Care” on Google Books, click here.

Some issues discussed in this post are extended further in articles located here.

To order Carol’s book, “The Commodity of Care”, you can order it online via the websites of WH Smith or Waterstones.