Photo by Dominic Hampton on Unsplash


Are we really surprised that the BBC’s  Panorama has again uncovered poor quality care and abuse in a home for older people?

We know the roots of this, and I have previously argued that this is a political game. This is also personal because, and this point has been made many times before, I will be old one day and may well require care. Therefore I do not want to be “treated like sh*t”,  as a resident on the Panorama film stated. It happens because the care sector is undervalued, invisible, ‘women’s work’ and it is thought by some that it can be done by those with little training, poor supervision, risible pay, poor patient ratios, no professional development and inadequate management.

Individuals will, of course, be blamed and sacked citing ‘accountability’ as if it is the holy grail of quality care and patient safety.

What to do? The first is to recognise that this personal trouble is a political issue and nurses are frontline staff in the trenches. In the UK for far too long nurses have been reluctant to use union power to address these fundamental issues. Yet, just when we need it, union membership across all employment sectors have dropped as workforces became more docile in the face of deregulated labour markets. Faced with the ‘flexibility’ requirements demanded by employers, resulting in the growth of zero-hours contracts, part-time working, minimum wages as targets rather than baselines, workers have become more pliable generally. Nursing, being a gendered occupation with its emphasis on self-sacrifice and care (Goodman2016), has historically shied away from exercising any worker power while simultaneously picking up the crumbs from the medics table (doing their ‘skilled’ tasks for nowhere near the pay) and now bowing to the control of their work as dictated by management.

In California, in the US, nurses are joining Unions and have a staffing ratio law of 5:1 for med/surg, 2:1 for ICU, and Psych 6:1. CA AB394 came about by the CA Nurses Association to implement their RN Staffing Ratio Law. William Whetstone (Professor of Nursing at California State University)  states:

Staff nurses were sick and tired of being abused, putting up with crappy workloads, incompetent nurse administrators and managers, and on and on. I can remember when I did staff nursing dealing with a patient load of 10 to 12 patients with no thought to their acuity. As a result, CA became the first state through the effort of the CA Nurses Association to establish RN-to-patient ratios. The law was successfully implemented on January 1, 2004″.

Is this an increasing phenomenon? Are we finally seeing a backlash against the dominant political hegemony that does not want to pay for care? We can study this until forever, but that fact remains – care costs. It costs a lot, requires skill and adequate ratios.

In California, it seems nurses have had enough, got organised and agitated for change. They have looked beyond the representations of nurses as caring angels and seen themselves as the exploited.  They have plucked the imaginary flowers from their chains and acted.

Many members of the capitalist executive (The Greedy Bastards) would not want this to happen because care is seen, by them, as a cost to be born not by society but by individuals and families. They instead want to fill our heads with distractions and representations using the ‘spectacle’ in order to facilitate their primary goal: capital accumulation.

Occasionally news media bring us stories of care scandals but this is usually light on analysis. Instead, we get a constant entertainment diet of ‘spectacle’ – anything from Strictly to the Champions League. Even war in the middle east is often served up as ‘spectacle’.

In addition, News and other media constantly feed us representations of the world that actually do not exist; they are constructed as ‘news’ and/or as entertainment. Panorama falls into that trap because it represents poor care in a particular way and is unable to drill down to the root causes. The TV itself is a medium of the representation of actuality and can lull us into classifying the poor care we see as almost entertainment; the lines between truth and fantasy become blurred.

“In societies where modern conditions of production prevail, life is presented as an immense accumulation of spectacles. Everything that was directly lived has receded into a representation”(Debord 1967).

Current forms of capitalism have ripped the citizen role from the heart of society and replaced it with consumerism in which we are presented daily with ‘the spectacle’ – representations of reality that are without form or substance but which serves to make that which is sacred instead to be profane. The spectacle specifically aimed at women include the array of women’s magazines which preach that you can never too thin or that your breasts require surgical enhancement; thus are we distracted about what is truly real by a false representation, within care employment contexts that are precarious, undervalued and invisible. Feminists know this, critical theorists know this, those with a sociological imagination know this, many women actually feel the cognitive dissonance that this engenders. In California,  nurses have acted as citizens, able to see past the distractions for long enough to see exploitation as it really is. In the UK those nurses who can see the reality, need support to take charge of care in this country.

Ordinary citizens need to organise their frustrations and anger over health and social care and cohere into a viable opposition.  We saw a spectacle of poor care again on Panorama, let’s not allow it to become entertainment for its shock value, lets instead urge action by all of us to provide the care older people deserve.


Goodman, B. (2016) The missing two Cs – commodity and critique: Obscuring the political economy of the gift of nursing. Journal of Research in Nursing. 21(4)