Progress? In the age of uncertainty

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	The Age of
	Uncertainty

'Over a relaxed weekend, a distinguished international gathering at John Kenneth Galbraith's Vermont farm offer their views on the themes outlined in the series and on other major anxieties facing the modern world.' 

BBC iPlayer
https://www.bbc.co.uk/iplayer/episode/m002l708/the-age-of-uncertainty-series-1-13-13-weekend-in-vermont

Book: Algorithmic Rule

ALGORITHMIC RULE

'The future is here and it is not simply digital; it is algorithmic. Algorithms now shape not only what we see and hear through the media, but also how public administrations function and how work is managed. Decisions about health, employment and even children’s education are increasingly outsourced to automated systems. This book explores the algorithmic present, and what can sometimes be described as algocracy – rule by algorithms. To navigate this new reality, we must ask not only technological but also democratic questions. This book is a guide to doing just that.

What national algorithmic scandals have already unfolded, and what lessons can be drawn from them? How is the future of work being reshaped, as employers rely on algorithmic management tools powered by constant workplace surveillance? Should artificial intelligence be allowed to make decisions in the public sector? Where can we find examples of local governments working for inclusion and transparency through open-source programming? How are institutions handling the massive and sensitive data flows that structure daily life? And what does it mean for democracy if the only face of the state becomes a ubiquitous chatbot?' 

Continued:

https://feps-europe.eu/publication/algorithmic-rule/ 

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	ALGORITHMIC
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Book: v 'Health and Health Care Inequities'

This final post for HHCI takes in -

Chapter 7: Searching for Socialism
Chapter 8: Mobilizing for Health Equity.

These themes are preceded at the close of chapter 6 with Arnel sharing some personal background, as an immigrant to Canada from a racialized background, who has worked in the health care industry (p.96). COVID also features again, its effects still resonate socio-politically.

It is an unfortunate conjunction - relationship as far as socialism, social justice, the green movement and social cohesion are concerned but Borras provides an invaluable service in linking the Capital-State alliance, which I have capitalised. It seems to be appropriate?

There is 'something' here (I think) in the 'identity' of governments, administrations - I will work through elsewhere.

Having added a note in post iv on expropriation, I see that 'precarity' is also included (p.98).

Chapter 7 gets to grips with 'Welfare Systems in Capitalism'. As before the details are Canadian, but with global reference to other welfare systems - liberal, conservative, and social democratic. If Marxism - Socialism was once feared for its seismic potential, I wondered if chapter 7 points to socialism being in a dormant state? Borras explains welfare state evolution and influences and employs metrics of trade union density, low-wage rates, poverty rates, and infant-mortality rates. On low-wages reference to the US as a capitalist powerhouse that does not provide a favourable environment for most workers, added to my thoughts about nursing globally and the US specifically: despite my parochial vantage point. Five tables aid international comparisons, with inconsistencies in data also highlighted. I couldn't help but feel the need to consider the impact of the wider-determinants of health. Now  undoubtedly, an emerging field. The discussion on infant mortality prompts thoughts of my daughter a mum-to-be amid health news in the UK. Plus, Labour's previous and renewed efforts in Sure Start; and the need stressed through Hodges' model to focus on ALL the literacies, including health.  

It sounds a contradiction but HHCI frequently had me thinking 'BIG picture' and detail. Reading 'US Empire' (p.110) made me wonder what descriptor might have been applied if written in June 2025? Social democracies are called to account. As a community nurse I am ready to support someone in making a change. But they must want and be the agent of that change. I can't support the individual in their drinking to excess - in the case of alcohol misuse/dependency. Social democracies and capitalism can operate as a conspiratorial dyad, limiting social and welfare progression. The lessons here are invaluable (pp.110-113). 

More could be made of the specific political impacts of technology. But clearly that would be another book. For example, no excuse, but BIG-TECH were clearly determined to start[-up] as they intended to go. They had a 'cleanroom' - clean-slate as far as unionisation was concerned. Governments permitted the same - paving the way, enabling and across continents. Ironic, the touchy-feely "We Care" with 'amazing offices', work cafés, dog areas, cycle paths, gardens, breakout spaces, and views. "Now, it is almost a religion: 'Give me a company until it is seven ...'. 

As socialism tries to overcome the past, and its associations; a political movement is needed. Somehow 'new socialism' sounds dated. There a call for openness in new ideas and ways to realise socialism. Over the past two decades work has changed, zero-hour contracts, part-time contracts, the rise of employment agencies and self-employed workers. It appears 'complex adaptive systems' can explain and help solve many problems, extending to human organisation and government. Yes. 'It is crucial to understand people's situations and value their experiences.' But how? And, how to 'encourage open conversations and learn from each other.' (p.114)? Neither 'citizen', or 'assemblies' are in the index, as with gambling and advertising. I may have missed one, or more in the text. You have a sense of a need for international organisation. Especially, with AI - artificial intelligence also in the wings.

The results of Erik Olin Wright's analysis of anti-capitalist movements does not sound convincing to me (pp.114-116), but then I'm a nurse. Perhaps economics itself needs to be looked at (again)? Is it an ongoing project - radical economics - that is? How does a new socio-political order 'account' for the existing distribution wealth? The paths toward health equity 1-6, make more sense. The political realism demonstrated, gives me reason to continue here. 

A brief section on electoral politics, brought me to short-termism. I have reached out to SIMPOL about this book and will share with the author.

[ Update 20/08/25: I've put the author Arnel in touch John Bunzl at SIMPOL. Short-termism remains an acute problems in our politics and policy. I've always worked clinically, so despite union and professional body membership, policy is something that has been done to my colleagues and I. There did seem some coherence with the National Service Frameworks. That may be illusory as they focussed on long-term conditions, but there was more:

Boardman J, Parsonage M. Government policy and the National Service Framework for Mental Health: modelling and costing services in England. Advances in Psychiatric Treatment. 2009;15(3):230-240. doi:10.1192/apt.bp.106.003095

They also had the attention of 'service user / carer specific organisations' -
https://mstrust.org.uk/a-z/national-service-frameworks-nsf

Last week, outside a large bookshop in Hay-on-Wye there were cabinets with books for sale at £1. With £5 worth under my arm, I was ready to go in to pay, and spotted 'Walk Don't Run' an absolute gem which I will post about soon. It links to the first post about Arnel's text and evidence. ].

Chapter 8: Mobilizing for Health Equity. Social justice: It seems the more it is spoken of (shouted even); the further it is to being delivered. We used to talk about minority and disenfranchised groups needing a 'voice'. Now social media amplifies the voice, that gets lost in the cacophony and chaos of information disorder. The 'essence of socialism' needs to quickly get to grips with capitalism as the need for 'labour' changes - is changing. We must listen to literature too: 'Some animals are more equal than others'. Class awareness and the role of unions is discussed. Education is critical. Perhaps we need more Philosophy in Pubs? People learn more effectively when they discover things, and arrive at conclusions for themselves. Use of guided discovery and Socratic dialogue have proved their worth repeatedly. This is why formative education is so important. Young people should be able to reflect and think critically. Within the education system the development of character and values too. That way: 'Workers must become political activists.' (p.126).

As a former health care worker there's a page (+) on engaging nurses in the fight for health equity. It is good to see I am probably right to assume the majority of nurses not 'politically active'. Hopefully, nurses and other formal carers reflect the local community and demographics. Although COVID revealed blatent structural realities. 

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LIFE CHANCES MY POTENTIAL MENTAL HEALTH	PHYSICAL RESOURCES PHYSICAL HEALTH
SOCIETY SOCIAL RESOURCES COMMUNITY	HEALTH ACTIVISM ADVOCACY POLICY CHANGE

On page 108 is '2SLGBTQIA+' below is a video that helps:

There are 'minimum demands' - Canada-centric of course. A look beyond policy change limitations and a short review of the need to establish a genuine socialist political party. This begs the question of how 'genuine' would be recognised. There may be a case study emerging in UK politics over the next four years? The bones are here in HHCI- no doubt about that.  More is needed, so it's encouraging there is no 'manifesto' in the index either.

Many thanks to Fernwood Publishing for my pb copy.

Arnel M. Borras. (2025) Health and Health Care Inequities - A Critical Political Economy Perspective. Fernwood Publishing.

See also - reference to Hodges' model:

Iris Lohja, Yves Demazeau, Christine Verdier. A multi-agent system approach to dynamic ridesharing for older people: State-of-the-art work and preliminary design. 18èmes Rencontres des Jeunes Chercheurs en Intelligence Artificielle, RJCIA’20, Jun 2020, Angers, France. pp.52-59. ⟨hal-02897446⟩

Spark! Strike! c/o - Ack Lemn Sissay

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"Long before the Bryant and May Factory was opened in Fairfield Road, Bow in East London, Charles Dickens wrote, in 1852, about the risks of ‘phossy jaw' in matchmaking factories. Yet, when the factory was opened in 1861, they proceeded to use the dangerous white phosphorus that caused the disease." https://www.matchgirls1888.org/the-story-of-the-strike

Spark Catchers by Lemn Sissay "... The greatest threat to their lives was The sulferuous spite filled spit of diablo The molten madness of a spark They became spark catchers and on the word “strike” a parched arched woman would dive With hand outstretched to catch the light. And Land like a crouching tiger with fist high Holding the malevolent flare tight ‘til it became an ash dot in the palm. Strike. ..."

 

Lemn Sissay

https://www.matchgirls1888.org/the-story-of-the-strike

https://blog.lemnsissay.com/2013/07/05/spark-catchers-the-matchgirls-festival/

My source: Radio 3 Words and Music.

In health, education, in work: We are all - Four Loom Weavers

"The author Michael Morpurgo (War Horse, Private Peaceful) explores the ways in which folk songs have reflected timeless human experiences, both in the past and today. 

Michael Morpurgo

With help from singers, songwriters and other passionate experts, Michael admires the indelible stories within classic songs that deal with migration, war, protest and love. Over the four themed episodes, Michael considers the locations and historical contexts that gave rise to much-loved traditional songs, and finds out how the same topics are inspiring new folk songs in the 2020s.

In the second episode, Michael considers a song of protest: Four Loom Weaver. 

With Professor Lawrence Goldman, Muireann Nic Amhlaoibh, Nancy Kerr, Karine Polwart, Nicola Kearey, Ian Carter, Blair Dunlop and Ashley Hutchings." BBC Radio 4

Michael Morpurgo's Folk Journeys

"Many Lancashire folk, can give personal testimony of relative having worked in such a role.

My maternal grandmother was a four loom cotton weaver until the mill, where she worked, in Rawtenstall, Lancashire, was closed and relocated to India in the 1920s approx. Mill workers worked their way up to four looms which were rented from the mill. Four was the maximum so my nan told me, so a four loom weaver was an indication of the level of attainment in the industry. So I think the title is probably correct and not a corruption of a poor loom weaver.

Will Lever, Malpas, Cheshire" Wikipedia

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"Enough (long since ...) already!" - #FairPayForNursing

 

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	'enough' "as much as is necessary; in the amount or to the degree needed: as much as or more than is wanted:"
	enough is ENOUGH

enough is enough

"something you say when you want something to stop:

Enough is enough - I don't want to argue with you any more."

 

https://dictionary.cambridge.org/dictionary/english/enough

 

Image: c/o RCN - https://twitter.com/theRCN/status/1321438463162540033

 

RCN Congress 2019 ii "We are all Global Nurses"

The debate about public sector vs. private sector healthcare touches all healthcare professionals. There is no escape. Despite this, from my 40+ years in the NHS - the NHS can act as a cocoon. It's as if the walls are adorned with "Keep Calm and Carry On". For some of us there is a 'keep your head down' mentality. While as a nursing assistant and student nurse, the words "Make sure you join COHSE, NUPE or the RCN" rang out; it was the day job, learning and family that had my attention. I wish I'd got to Congress decades ago.



You can't do everything and this lack of involvement is a blessing in a way. For example, without ever taking anything for granted, I never imagined I would need the help of my union/professional body. When I did and 'we won' thanks to a brilliant RCN Rep. Being represented has this quality to it. Unless, you are an activist, it is a newsletter, journal, annual pay discussion, but this opened my eyes. As a consequence, I encourage students, even more so and others to ensure they are represented and get involved.

To Congress itself: I was surprised and disappointed to hear several years ago about the RCN's cessation of links to the International Council of Nurses [ICN]. Further surprise followed when a Congress debate revealed it was five-six years ago in fact:

Members vote to allow RCN to leave international nursing body

£600,000 is 'politics' in the raw for membership and the RCN Council. The cost of ICN membership  was debated at Congress. There are various arguments. This seemed a break on many levels; social, political, psychological and scientifically.

(Bizarrely, perhaps this state of affairs says something in support of reflection. When the latter is accused of fostering navel-gazing, finance and value for money ... speak volumes, but the RCN's global isolation is navel-gazing realised aggravated by the ongoing psychological experience of Brexit.)

In championing Hodges' model as a global resource for healthcare and education, my parochial perspective from Wigan Pier has felt acute. Online I've long nurtured links with global nursing and healthcare groups: HIFA, HIPNET, GANM, Nursing Now and others. In workshops with nursing students and other disciplines, the ICN and global nursing context is always stressed (the ICD too). [After all, as students and lifelong learners these people do have the World at their feet.]

The relevance of Hodges' model increases daily and - my bias aside - the model's significance is crystalised in this issue for the RCN and its members. As noted in the debate John Gilmore raises the matter of refugees. For those in crisis through natural disaster, conflict and crime amid chaos there is geopsychiatry and the mental health implications for children and future generations of this 'lived experience'. As we await further news on this, below I have mapped key elements of the debate in Hodges' model:

There is a digital archive for members to watch the debate.

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"The WORLD of Nursing"

Philosophical: Values, Philosophies of Care Mental Health Mental Health of Nurses Parity of Esteem - geoPSYCHIATRY Ethel G. Fenwick and others [ Health Education & Promotion, Sustainability ]	The 'GEO-' in Nursing Nursing logistics Research; Collaboration, Multi-center, Evidence, The 'UNIVERSAL' in UHC Definitions of Nursing Roles Skills & Knowledge Coding & Classification initiatives Global: 20,000,000 nurses ICN predates RCN 'transparency'
The Nursing Community "Voice" 1899 ICN formed SOCIO-[Economic] status of nurses The global: Community of Practice Collegiality Cooperation Collaboration Fellowship "We are all global nurses."	'political' POLICY: Workforce, Migration, Recruitment crisis Safe Staffing (National, Global) Medical Emergencies, Climate change Working groups: Standards, Issues Funding, ICN, RCN and other bodies Support for Developing Nations LMIC The Scope of Nursing Stewardship ICN - Membership model PAY restraint, austerity As of 2013: £614,470 / £1.42 per member Business case

How do you measure the impact of an organisation?

2020 - International Year of the Nurse

20:20 vision IS global

https://en.wikipedia.org/wiki/Keep_Calm_and_Carry_On

RCN Congress 2019 i

Last month I finally attended a Congress of The Royal College of Nurses. The time was my own: from the Sunday evening to the Thursday. I'm really grateful to the NW Branch for some financial support as I did stay over, even though it was on my doorstep being in Liverpool. I live between what is the city of my birth (L9, Longmoor Lane) and Manchester.

I knew beforehand that it was unlikely that my proposed item for discussion was unlikely to be accepted. This was immediately obvious when I read the final agenda. Even then there were additions as I could see the mechanics of Congress. There were many more important, timely, critical issues to discuss and debate. What stands out though is not just the funding support but the fact of being encouraged to write something, which wasn't wasted as I posted my item in February (a living draft - that may have a long tail). The human side was inevitably in evidence too: accessibility issues, misunderstandings, things said, things apologised for and vulnerable and minority groups acknowledged and championed. This isn't nursing navel-gazing either. From local experiences, to national there was also an international and global view. Students, the future: were very much in evidence and Congress learned - or more likely were reminded - that they can be disruptive, unpredictable, energetic and they have a voice.

As I watched, listened and learned, the organisation (that's the event itself...) is equally and variously: tried and tested, slick, flexible, responsive, progressive, accepting, friendly, caring!, strident, testing, emotional (yes, moving), celebratory, tiring, educational, inspiring, social and potentially a bit overwhelming ... As you may of gathered - the adage; "you get out of things what you put in" applies. As is often the case I did not do as intended and 'network'. Congress acknowledged the overwhelming/isolating sense in extolling people to reach out to the people around them. If nurses cannot do that then we are in trouble. I kept meeting the same people and it was a great support to have that connection and company. That said, the lack of places to sit at an evening social did not lend itself to getting know fellow members. Standing at a narrow bar eating a hot meal was helped by having to share the ergonomic challenges; an unfortunate but helpful ice-breaker. This was raised as an issue at Congress itself.

There was a political undercurrent with several references and overheard comments pertaining to the RCN's role in negotiating the last pay deal and last year's Extraordinary General Meeting. There is unfinished business here. Not just for the RCN, but the government too. This debacle undermines trust on so many levels, especially after the past decade as experienced by nurses on the 'shop floor'. If that is not painful enough, this matters because it is corrosive generally. While choice matters and yes, health care is an 'industry', the vast majority of us do not want to work in a 'shop'.* We know where to find all the concepts associated with politics in Hodges' model. But, as the social and intra- interpersonal (mental health) domains have atrophied, we must ask where is the NHS on the political grid? A grid that also impacts the whole NHS workforce, social care (don't ask!) and vitally the shaping of career choices for would-be future nurses.

Post ii to follow ...

* How times change? I smile ruefully of how over several decades nurse colleagues have rhetorically suggested that they may look for a job at M&S or John Lewis. What price the retail sector now..? Another post ...?

Self-employed?

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Self-
	employed?

Related links:

BBC news: Who do I really work for?

Office for National Statistics: Self-employed workers in the UK - 2014

Prospects: Self-employment

NewStatesman: Is being self-employed becoming the new normal?

Low Incomes Tax Reform Group of the Chartered Institute of Taxation: Self-employment

The profit motive and health currency

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	"... They tell us that temperatures are still unbearable, that it’s consistently scorching hot. And it’s getting worse as the weather heats up. Workers are fainting every day. To cope, they use a traditional technique called “coining”, where they scratch their skin with coins to bring blood to the surface of the skin. It’s meant to relieve the stress and fatigue caused by the heat. ..."
	A Kin Tai factory worker getting “coined” by a coworker on Monday.

When people are exploited and in the absence of health services and evidence-based health care information, they may resort to traditional remedies to try to solve acute health problems. When the control of the work environment is also beyond the worker's control then acute problems and risks to health are bound to follow.

My source: France24 TV English Service

Web: Cambodian workers 'keep fainting from heat' while making Armani jeans:
https://observers.france24.com/en/20150513-fainting-heat-factory-cambodia-armani

RCN survey on NMC fee increase: what do you think?

FROM the RCN:

BREAKING: The RCN has today launched a new survey to find out what YOU think about the proposal by the NMC to increase your annual registration fee from £76 to £120.

We oppose the move strongly, but we need to know what you think too. You answers will help shape our official response to their consultation so it's vital that you have your say.

Complete the survey now, it takes two minutes. (Alex)

http://frontlinefirst.rcn.org.uk/page/s/NMCsurvey

My comment:
No doubt like a huge majority of the population I have personal reasons for total disbelief, disrespect in the banking - finance sector. This is in addition to the bailouts that we are ALL still paying for and it isn't over yet of course.

This NMC fee increase makes me very angry too. If you're a UK nurse you should be incensed.

As the public sector cuts continue with worse to follow apparently the pressures on nurses will increase. As a result resources will be further pinched, with short-cuts in care mistakes will inevitably follow. So the increase in costs incurred in managing disciplinary matters are bound to rise as a consequence. This is a trend that must be stopped and properly addressed now.

Now you want me to contribute to an NMC bailout?

This is no way to manage professionalism, accountability and governance. ...

I appreciate that as an organisation the NMC's hands are tied - it must seek funds to maintain its work, fulfill its role. But, please don't hold me and the UK nursing workforce hostage at the same time.

Additional link:
http://www.rcm.org.uk/midwives/news/unions-rally-against-proposed-nmc-hike/

Advocacy No. 1

What’s your view on nurses as advocates?

For nurses advocacy is seen as a constant facet of the role. It may not be as pronounced these days, but it is always present. If a person (patient or carer) needs an advocate in that 'non-legal' sense, then as nurses we are ready and willing to assist and present the patient's views. Quite a few years ago there was much navel-gazing that questioned the appropriateness of nurses as advocates. Where are the boundaries and how do you define non-legal? How independent can nurses be?

This no doubt presaged the advent of formal and dedicated advocacy worker schemes, a development reinforced by the emphasis on human rights over the past decade. Rather than travelling along the care pathway WITH the patient, carer(s) and health care team, advocacy workers are ready to get involved - independently - as the care situation reaches a crossroads (and pauses momentarily). In my experience though it is not easy to find longer-term independent advocacy input. Sometimes it is the very need to call 'time' - to seek space to reflect and weigh pros and cons - that is an issue.

Unless their role is radically changed, nurses will always be an initial advocate. Nurses are in the midst of care, their privileged relationship and proximity to the patient, their knowledge of the issues, diagnosis, interventions and prognosis makes advocacy a natural (caring!) response. I raise this because if advocacy is a political concept and the nurse’s role as advocate is less than it used to be, then what is left - beyond the political essentials of pay & pensions?

This blog is in danger of becoming a litany of examples by which I reveal my age. ... Back in the late 1970s and 1980s nursing was far more political and in the UK those were certainly employee-employer troubled times. They had quite an effect did those Union badges! Metallic drops of red, blue and green that adorned so many lapels, instant decoration for the grey suit with waistcoat that I used to wear (my mum thought I looked smart for once). Mental health always seemed more, shall we say union-attuned, than general nursing and yes the power of the unions had a lot to answer for in the UK; but where are we today?

Acting as an advocate you really can make a difference. Individual needs are nursing's bread & butter; but why stop at one person, when the needs of the many...?

Perhaps my view on this is a personal illusion, brought on by the purchase of Jane Salvage's ‘Politics in Nursing’ (1985)? Did this book, like most, merely reflect the times? I must confess the book did not 'activate' me. (Although, as the website may demonstrate, my head was lost above the clouds.)

In my student and early years the advice was keep your nose clean; deposit your assignments on time into the school of nursing's coffers and get through the current placement. There were exceptions as might be expected in a huge aged asylum, though thankfully when necessary action did not fall upon the conscience of one individual (that takes real conviction, courage & dedication). The issue was 'public' witnessed by several colleagues, all dedicated to high quality care. A case of a problem shared…...

The point of all this: If nursing has largely withdrawn from the role of advocate, than what is left politically? Maybe for you nursing is still there, the sparks flying as the activists sharpen advocacy's edge? The nursing pioneers Nightingale, Seacole, Makiwane, Breckinridge, Walking Bear Yellowtail, Peplau; and many others set an agenda. To what extent have we (nurses) addressed this? What remains to be done and what new challenges do we face?

The pioneers made a real difference. Not only did they build the ship, they set us on a course. If I were a student I'd be shouting "Are we there yet!" Has nursing arrived? If not, why not, how can we correct course and where - in the time of constant re-invention - is the new horizon?