Bring back the Britain of 1939 - We need good governance to cope with Crisis
Crisis is a very important word. Its origins are in Greek medicine so it has been around for some 2,500 years. It describes that crucial period in the course of an infection when either the sick person’s immune system overcomes the disease and they get better or the disease overcomes the immune system and they die. Before (and perhaps after) effective antibiotics that is how it went. That is how it will go with a 'Corona' infection which is virus-based. The key point in the general use of the term is that crisis describes a period in the state of the system which cannot continue. It must result in a radical change of kind, in a phase shift, in a system transformation. Things cannot go on as they are – they must change. James O’Connor’s The Meaning of Crisis (1987) introduced me to that etymology and understanding of Crisis and as soon as I encountered ‘Complexity Theory’ or as I now prefer to say following Brian Castellani, ‘the Complexity Frame of Reference,’ I realized how apposite the term was to understanding meaningful change in complex systems. Crises are when things change:- "The crisis consists precisely in the fact that the old is dying and the new cannot be born; in this interregnum a great variety of morbid symptoms appear (Gramscii)." "And what rough beast, its hour come round at last, Slouches towards Bethlehem to be born (Yeats)?"
In this world today we currently have crisis piled upon crisis – a public health crisis with an immediate impact, piled on top of a long running crisis in the place of humanity on this planet through our capitalist industrial systems' creation of global warming. When 'Corona' hit, I was in the middle of writing a book on Inequality in a context of climate crisis: a complex realist approach. I intend to carry on doing so whilst planting for the first time in years every seed potato I have bought and digging up even more of my lawn – digging not for victory but for survival. Before doing the writing (although the lawn has suffered already), I am going to rant from a complexity perspective on what is needed in governance to cope with both the immediate crisis of corona and the not so slow burning crisis of global warming. It is the same for both. We need governance in which market capitalism is subordinated to social objectives. The political necessity of coping with an existential crisis must dominate capitalist market relationships, and where necessary replace them by expropriation and systematic planning. For all complex systems in a state of crisis it is not a matter of what will happen, but rather what social action will make happen in relation to the multiple possible futures of the system.
The 'Corona' pandemic can be understood as Gaia biting back. The Nobel prize winning novelist William Golding, a friend of Lovelock who coined the term ‘the Gaia hypothesis’, remarked that when he was introduced to the idea he heard Gaia in the voice of his mother herself saying: “Don’t care was made to care”. The social and economic and cultural systems of humanity are embedded in and dependent on the systems of nature. Our abuse of those systems in the era of the Capitalocene (watch Jason Moore explain this term) is central to the crisis in our relationship with nature, which up until now we have understood in terms of the consequences of global warming. 'Corona' is another manifestation. What we have in England – and I have to note that things in Scotland and Wales are not so bad in so far as the governments of those regions seem to be using their devolved powers a bit more constructively, although they do not have enough power to do what is needed – is a governance system which is wholly inadequate for the management of a crisis on this scale and remains committed to the ideology and policy programmes of neo-liberalism, the sovereignty of the market, and the weakening of the role of the state at every level.
'Corona' is a crisis because of our failures in Governance.
Just like the Irish Famine of the 1840s where more than a million people died within the territory of one of the richest countries in the world, my great great grandmother and two of my great grandfather’s siblings among them, serving as The Economist put it at the time the useful purpose of reducing the surplus population, this is a crisis where nature has hit us. The ideological and structural frame of the neo-liberal state now, just like the ideological and structural frame of the laissez-faire liberal state then, is wholly incapable of dealing with it.
One of the most useful ideas of social science is that of path dependency. What has been done in the past shapes what can be done in the future. This notion is wholly congruent with the complexity frame of reference in understanding how social action can shape the future trajectories of complex social systems. Complex systems have multiple but not infinite possible futures. The most common is that things stay much the same in essentials, but all change that matters in complex systems is change of kind, rather than merely incremental change in degree. Societies like ours – what were the great industrial and welfare capitalisms of the post-second world war – have already undergone a ‘great if partial’ transformation. They remain capitalist and organized even more around the logic of markets but are no longer industrial systems (see my book Class after Industry for a full account of what this means). This economic and political change, which also has profound cultural consequences, has led to a crisis of political legitimacy across high income democracies because of increasing social inequality.
Global warming represents a challenge which is well understood in scientific terms, precisely through the complexity frame of reference, as a fundamental change in natural systems with profound social consequences. Now we have 'Corona' – which is first a crisis for public health understood in terms of population epidemiology, but behind that lies fundamental failures in the structures of governance in neo-liberal states. The UK is not in the extreme position of the USA where federal government is headed by a pathological liar who denies the validity of science, and the government lead on these issues is a Christian fundamentalist VP Mike Pence who is just as dangerous. There is some attention being paid to science but mere epidemiological science is not enough as a basis for doing the things that need to be done now. What is needed is a fundamental shift in the character of governance and a subordination of market economic systems to the social need to confront this impending disaster. And this is not just a matter of sorting out the governance of public health to deal with 'Corona,' important though that is. Most if not all aspects of governance need to be done differently if we are to have a cat-in-hell's chance of coming out of first 'Corona' without thousands of deaths, and second global warming with something like human civilization still intact.
England (although not the devolved nations) was, before 'Corona', in the process of setting up the NHS for privatization of provision with private providers paid from tax revenues. Alex Scott-Samuel sums it up exactly (email to the Political Economy of Health Group 21/3/20):
Why have we had this appalling insufficiency of PPE [Personal Protection Equipment] and testing kits in the NHS and in the community? The problem is due to NHS England’s Long Term Plan which is central to the government‘s commercialisation of the NHS. It’s only because NHSE’s LTP is not yet fully implemented, that we can have any kind of national response at all. By splitting England’s NHS into 42 ‘integrated care systems‘ with tight restrictions which prevent the sharing of staff, resources and equipment that can occur with a national ‘risk pool’, the long term plan has made the creation of sufficient reserve supplies for emergencies impossible. Everywhere in the country is in financial deficit. NHS Supply Chain’s ‘demand management controls’ have been preventing fair distribution of what little equipment is available. A proper public health response to COVID-19 would include full community testing and contact tracing (as recommended by WHO) but this has been made impossible because of local government and public health cuts by successive Conservative governments.
Everything that has happened to the NHS since 1979 has been a move away from its original organisation as a nation-wide system whose administration was managed by subordinate levels that had necessary autonomy but remained part of an overall system, which was managed by planning. The absurd argument that markets would create greater efficiency, asserted by ideologues who seemed wholly ignorant of the reality of transaction costs or the nature of imperfect competition in the real world outwith their fantasy posited models, was translated into policies which made the NHS much less capable of dealing with an existential crisis like 'Corona.'
The great irony in this is that the NHS was created in embryonic form as the Emergency Hospital Service in 1939 by nationalising all hospitals, administering them on a regional basis, in order to cope with the massive casualties expected from Nazi bombing of civilian targets. Thanks to other elements in the system – radar and very efficient organization of air defences - those casualties did not materialise and the hospitals were used to deliver the first free universal hospital care. In Scotland seven new hospitals were built from scratch, annexes were added to existing hospitals, and hotels were commandeered to provide additional cover. This was at a time when building techniques were less efficient, resources were needed for coastal defence, and in 1940 much of the country was under sustained air attack.
A key element in the very efficient organization of economic and civil life in the UK during WW2 was the regional level of administration. In England in 2010 the Coalition government abolished the very useful framework for regional level coordination in the form of Government Regional Offices, supposedly to eliminate a level of bureaucracy and restore democratic control to communities – and the band played believe it if you like. The neo-liberals hate any form of sub-national government which they can’t control. The wretched US Heritage Foundation actually used a UK version of itself in kyboshing the NE Regional Assembly referendum. English organization of health care has been increasingly fragmented through the last twenty five years. In 1994 there were eight regional health administrations corresponding outside London and the South East pretty much to English administrative / statistical regions. These were in turn abolished in 2012 by the Health and Social Care Act, which was clearly intended to set up the English NHS for privatization, and replaced by far smaller scale Clinical Commissioning Groups of which after mergers there are now 191. These are purchasers of services rather than planning bodies, although they have played a role in hospital provision reconfigurations. They are wholly incapable of managing health provision in a pandemic. Public Health functions at a local level were transferred from the NHS to upper tier local authorities. Funding for these functions has been cut by more than 10% in real terms in recent years alongside other radical cuts in local authority funding for all services. In Scotland, in contrast, Public Health is the responsibility of a special Health Board with a national coverage and this looks likely to have the capacity to act as a planning body at the appropriate regional level. Public Health Wales has a similar status and potential capacity.
So the UK is in a mess, in England it's a hell of a mess. What can be done? What should be done?
Sound the Sirens
On the outbreak of the Second World War Air Raid sirens were sounded primarily of course to get people to know what they were, but also a symbol that things had changed and would not be the same again for a long time, if ever. And that is where we are now. The UK in the Second World War was the most effectively planned and managed economic social system there has ever been anywhere in the world – far more so that Nazi Germany and even more than Soviet Russia – effective though planning was in the USSR once Germany had invaded. Pat Devine’s outstanding Democracy and Economic Planning (1988) outlines how the UK went far along the road of ‘democratic planning through systematic coordination’. I am wholly convinced that in the medium-term we will only be able to survive the impact of global warming if all governance is organised on something like that basis, but in the short-term there are many things to learn from what was done then, and what is being done in contemporary China, in order to minimize casualties from 'Corona' now. Do everything that can be done which means:
Close unnecessary places for contacts – done
Advise on restricted social contacts – done
Quarantine cases – done in part
Quarantine contacts of cases – not done – doing this is why China has coronavirus on the run FOR NOW (read a really expert and informative piece in New Scientist).
Test to establish incidence and prevalence – is this being done?
Test to establish recovery – fit adults who have recovered and are no longer infectious will be a vital labour resource – not being done (but anti-body tests are currently being evaluated ahead of priority roll-out).
Manage access to essential goods – not really done other than by private providers in a very limited way. Do we need rationing? Tim Lang – a real expert who we need to listen to thinks we do.
Solve income problems for people who are laid-off – done to some degree, with new measures announced for 95% of self-employed. Still some way to go, especially for 'gig economy' workers and those who fall outside existing programmes.
Staff-up health care - doing. Final year medical and nursing students are being drafted into hospitals and this right. Over 18,000 fully-trained staff have been 'bought-in' from the private sector. Former or retired health care staff are also returning in their thousands. All medical, dental and professions allied to medicine students should be on standby to move into health roles.
Staff up domiciliary social care - doing. I would conscript but I am very authoritarian. Perhaps it will be enough as the pandemic develops to ask students and other fit young adults who have had symptoms and reached a phase of recovering and non-infection (see this link for information on when this will be) to volunteer for testing to establish non-infecting status and then staff up domiciliary social care / meals on wheels / and other care for people at home and in care homes. Actually to be fair I think most of them would jump at the opportunity. Several of the lovely Chinese students I used to teach on the MA SocRes had volunteered to go in to help after the 2008 Sichuan earthquake. I think our young people are just as public spirited. A call for volunteers has been made (with over 500,000 signed-up already) but no indication that this is associated with testing and that should be vital.
Don’t let the Best be the enemy of the adequate and doing some good.
We need corvettes and sten guns – not the best possible, but good enough. Churchill described the Corvette – a whale catcher with a gun on it, depth charges and simple engines that could be quickly built by merchant shipyards as: 'cheap and nasty – cheap for us and nasty for the enemy.' Sten guns were cheap sub-machine guns which were not the best to be had but could be produced in enormous numbers and got the job done – killed fascists.
We need loads of ventilators – (see this link from Canada - Canada built lots of Corvettes by the way and sank lots of U boats with them). Gear up immediately and convert a lot of light engineering production to cheap adequate ventilators. Make sten guns not Purdy shotguns. Some companies, such as Dyson, are starting this work - doing a bit.
Build cheap and basic hospitals in long runs of huts and commandeer hotels for conversion rapidly to hospital provision using existing domestic staff – get the elderly ‘blocking beds’ out of hospitals into hotels – 5 star for preference. There are moves towards emergency hospital provision, in particular establishment of a large 'Corona'-focused hospital in an East London Convention Centre, as well as others in Manchester and Birmingham, but this has to be a systematic nation-wide process.
AND THIS IS NOT GOING TO GO AWAY!
'Corona' is now a human disease and is here to stay. The Chinese Government has recognized this and is planning for the future (see again the New Scientist piece above). We need to be doing this as well.
In England we need to re-establish regional governance and integrate this very closely with public health. There should be a Regional Commissioner, preferably a Local Authority Chief Executive with a good record and a career solely in the public service, and a Regional Director of Public Health drawn from existing Directors of Public Health. This is a necessary administrative level and we need to set it up now. They should be working, virtually if need be, with teams on what happens after the first wave of 'Corona' peaks. Scotland and Wales have the necessary administrative structures in place. They provide good models for what needs to be done in England. We need to see beyond the immediate, much as we need to do things in the immediate.
I make no apologies for ranting in this blog. A rant is what is needed.
David is an Emeritus Professor in the Department of Sociology at Durham University.
New Scientist is blogging regularly on Corona – here is a recent one – nought for your comfort.