The Commodity of Care

A patient “I am me”

Poor care is taboo in nursing. Yet it has festered like  a sore , for many years. Within the  USA, Australia, UK- there are historical links to workhouses, where the “non-deserving poor” were harboured . 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 is affected attitudes toward treatment of the ill, and is still prevalent. For example there were restricted diets or harsh treatment within workhouses. The mentally ill were flogged , albeit with declared good intentions to drive out evil spirits.

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

More so within the forgotten areas of care for the most vulnerable, such as care homes for older people. More so within the private sector- owned by private equity trusts, which means we do not know who really owns it and who is ultimately responsible. Privatisation 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.

This is one of the many aspects explored within the book “The commodity of care”, which I undertook  (with some help of t.i.m), and surprisingly, we are unconnected to any university or nursing organisation.

Consider the case of  a patient, who is deliberately sat on by  a 28 stone carer assistant, or patient who is shouted at by  a qualified nurse; these cases involve attitudes- not as many would prefer to declare, short staffing. Short staffing surely causes a different type of poor care- omissions .

Poor care occurs in many forms from errors ; such as forgetting to write in a care plan, or drug error (which may result in death or harm of  a patient )- 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 on legal websites, or alternative new sites. ABC Australia is particularly useful . Why then do cases appear to be hidden?

Many would appear to prefer to disbelieve such cases, as they consider there is nothing that can be done. Some believe them to be “one-offs”. Others are guilty or ashamed. Some businesses would rather protect their business and gain profit. Many staff and students, are unaware of what to do, or afraid of challenging the system. Herein lies implications for education; we so need to prepare students instead of denying that poor care exists. Within the UK, education also , needs addressing. The nursing course differs between Universities, as do other courses such as social work. Of course it depends on skills and experience of lecturers and modules are established by the University staff. Yet the private sector in the UK does differ from the NHS sector, and is very neglected. Indeed, differently owned private establishments, do differ from one another.

What of the staff themselves? All 3 countries employ a large number of nurses from overseas- and care assistants. Nurses from overseas, are cheaper and complain less. Yet fake certificates are very easy to obtain via the internet. They may not visibly be recognisable from the real thing. Indeed a phone call, or visit, may take you to  a car park. Many blogs, and news reports, suggest that there are  a high number of nurses with fake certificates in all countries. Some staff may recognise them by being followed around on shift, or questioned about simple procedures.  This book suggests that finger printing, 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 the home trained country. Many private care homes and hospitals, have contracts for  a supply of overseas nurses . Many countries are considering  a cheaper alternative to qualified nurses. One example is offered by Florida.

So what can be done about all of this? Many argue- talk publicly only of good care. Of course there are many examples of excellent care.This is brushing the problem under the carpet. Nor does it protect patients and staff who wish to challenge the system. In all 3 countries, the complaints procedure is questionable. Within the UK, it is more difficult to complain about the private sector (who can ask you to leave), than the NHS. Yet in any case, when problems reach the 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. This is the problem in care.

 George Orwell “All animals are equal, but some animals are more equal than others”.

 Dimon C (2013) The Commodity of Care Cloister House Press

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