Health – We Know Zero

Models of the first and second kind

09. September 2026 · Write a comment · Categories: Actuarial, Economics, Education, Health, Professions, Science Fiction

Copper parts of a vehicle have been mounted on a much larger wooden structure in an exhibit at the Vatican Museums — *My photograph of an exhibit at the Vatican Museums*

Worldbuilding in science fiction has certain rules, or so I thought. And the first of these according to some sources at least seems to be consistency. According to the Quirkworthy website:

The basic message is very simple: your world must be internally consistent. Doesn’t matter if it’s science fiction or fantasy, and it makes no odds if it’s a novel, game, or opera. At all times, your world must be consistent to itself.

So when Jeff Noon and Steve Beard came to the Birmingham Science Fiction Group a couple of years ago, I pricked up my ears when one of them (Jeff I think) said that the first book of the Ludwich Chronicles, Gogmagog, which they were discussing, was not consistent. They were following Cady Meade’s viewpoint which journeyed 60 miles along the river Nysis inside a ghost and the focus was to set a particular mood. It was built from the bottom up.

This idea appealed to me then, and has, in my view, become a more and more important idea recently. We all build our views of the world from the bottom up based on our own experiences and they are frequently inconsistent with those of other people. The problem comes when we stop accepting that and treat our models as, in some way, top down and universal.

I had a great example of this a few years ago in the Vatican Museums. Some bits of bronze they reckoned to be parts of a cart buried in an Etruscan tomb had been discovered and were then displayed on an entirely speculative wooden model of a cart (to be fair to them, the Monteleone chariot dated to around 530 BC, was a rather more complete find and the wooden model looks like it was modelled on that). The trouble is, once you have seen the pieces on the cart, it is difficult to think of them in any other way. Rather like some of those early dinosaur reconstructions and possibly unhelpful in a field as fast-moving as archaeology.

Source: The book of the great sea-dragons, Ichthyosauri and Plesiosauri, [gedolim taninim] gedolim taninim, of Moses. Extinct monsters of the ancient earth. With thirty plates, copied from skeletons in the author’s collection of fossil organic remains, (deposited in the British museum.) *by Hawkins, Thomas, 1810-1889*
*https://archive.org/details/bookgreatseadra00hawk/page/n5/mode/2up*

We do this everywhere. Every competitive market is a model, as relentless in its pursuit of victory within the rules (all of which must be stress-tested as to how they are going to be applied by each individual referee in each individual encounter) as the Premier League. Sometimes if you question some of the underlying assumptions behind some of these models, you are told that is just the way the world works.

But the way the world works is opaque. Novelists have attempted to show us glimpses of it for centuries. Historians are sometimes able to agree about how it has worked in a specific geography for a short period of time. Occasionally, as a result of our own experiences, we may feel that we have managed to grasp some truth about the world and how it works in our own lives. But often the clarity slips through our fingers when we throw more light on it. The clarity certainly never seems to last that long. For clarity you often need an organisation signed up to a model.

Much has been written in recent years about our dependence on models and our inability to look outside them in many cases, most notably Escape from Model Land by Erica Thompson. This has mainly focused on the models we make to try and understand the world. But there also models behind those models which effectively determine what kinds of models of the first kind we create. These are the organisations and institutions we look at the world from.

It was in a time of rapid transition and uncertainty much as our own is that the groups of organisations we call professions emerged in the nineteenth century. The model of the second kind they adopted was partly that set out by Daniel and Richard Susskind in their book The Future of the Professions.

According to the Susskinds, there is a Grand Bargain between society and the professions, which means (and I am paraphrasing a little here), in return for professions providing:

Expertise, experience and judgement;
Delivered affordably, accessibly, reassuringly and reliably;
With knowledge and methods maintained and kept up to date, members trained, standards and quality of work enforced and only appropriately qualified individuals allowed in;
Acting honestly and in good faith; and
Putting clients’ interests ahead of their own.

In return, society will give the professions:

Respect and status;
Exclusive rights to perform/provide socially significant activities or services; and;
Independence to decide how they do it and how much they can be paid for it.

What professions expect from society is jealously guarded. My own profession’s uneasy relationship with the universities can plausibly be traced back to Newton’s influence on what mathematics could be taught there, therefore denying actuaries the status they craved without setting up their own professional bodies to supply it. The last attempt to allow an allied profession to carry out limited medical activities ended with the Leng Review effectively strangling it, egged on noisily by the BMA. And it is not hard to find articles defending increases to executive remuneration way beyond that of the people who work for them as the norm.

What society expects from professions often gets less attention directed at it. Four of the five bullets above tend to form part of the professional code of most professions in some form, although there are frequent fines of large professional firms for failures in the standard of the services provided.

But what of delivering professional services affordably, accessibly, reassuringly and reliably? What has tended to happen, as the group of people requiring professional services has widened, is that the affordability and accessibility have been increasingly called in to question. And online self-service looks likely to be attempted for a wider and wider range of services as time goes on.

So is the professional structure we have going to remain? If the experience of the nineteenth century, when most of these professions emerged, is anything to go by, the level of disruption will vary hugely by profession and institution and the period of transition could be very long in some cases. But it seems clear that such a period has begun. This has serious implications for actuarial education, amongst much else.

And whatever replaces them is likely to be built from the bottom up.

Normals: new and otherwise

25. August 2026 · Write a comment · Categories: Actuarial, Climate Change, COVID-19, Economics, Health, Media & Politics, Risk

Climate campaigners get very irritated with media talking about the “new normal”, pointing out, quite reasonably, that for it to be the new normal would require a degree of climate stability that we have not got, nor have any prospect of getting while we continue to argue about whether net zero (the policy, remember, which is about moving us to a position where we don’t increase the amount of carbon in the atmosphere year after year) is affordable. Poverty and health campaigners got very irritated by the call to “get back to normal” after the pandemic, when it had so clearly demonstrated how our “normal” way of organising society had failed to protect so many of its citizens. As even I could see in March 2020:

My view is that some things that must be different post COVID are already clear. I think as a society we are going to demand more resilience, for example:

Resilience of our health service – this means much higher levels of spending, building deliberate over-capacity into the system in normal times;
Resilience of our food supplies, for example strengthening domestic supply chains;
Resilience of our population, so that we do not have 1.6 million food parcels needing to be given out in a year by the Trussell Trust, in the absence of a pandemic, for instance; and
Resilience of our infrastructure – to everything from floods to banking crises to pandemics to storms and heatwaves.

A picture circulating at the time of a Santiago apartment block with a projection onto it of “No volveremos a la normalidad porque la normalidad era el problema” (we won’t get back to normal because normal was the problem) was actually taken the previous year when the Chilean President had used the word “normality” to justifying lifting the state of emergency, leading to large protests:

Source: https://x.com/inesmorsantos/status/1190192093165211648?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1190192093165211648%7Ctwgr%5E%7Ctwcon%5Es1_&ref_url=https%3A%2F%2Fodi.org%2Fen%2Finsights%2Fcovid-19-we-wont-get-back-to-normal-because-normal-was-the-problem%2F “We won’t go back to normal, because ‘the normal’ was the problem.”

But we all have trouble with fast moving situations, or even just moving situations. Remember the media coverage in the early weeks of Covid utterly focused on the number of cases going up each week rather than on the underlying pattern this showed, which had been predicted and could be responded to.

In the Institute and Faculty of Actuaries syllabus, subject CS2 Risk Modelling and Survival Analysis has 20% of its content on dealing with our trouble with moving situations via time series:

It boils down to a number of tricks to turn our moving situation into a non-moving or stationary situation, which we can then analyse.

So not being able to deal with things that aren’t stationary is entirely normal. Indeed the Standard Normal Distribution, originally developed in response to a gambler’s query and another thing that we spend a lot of time transforming other distributions into if we can, has a fixed mean of 0 and a fixed variance (a measure of how far things stray from the mean) of 1:

Outside statistical analysis, we use different techniques to make things appear normal. Denial, ie ignoring the departure from normality, is a big one. When this one is no longer tenable in the face of mounting evidence that we are not in Kansas anymore, we often try and depict where we have got to as normal now. This will have been a good strategy in the past: once a natural disaster has passed, taking stock of what has been lost and what remains and working within these new parameters makes more sense than hankering back to how things were before the disaster struck.

However this strategy comes unstuck when one or both of two things are true:

The disaster, or change-event more generally, is not a one-off but a continuing process.
The way we were living before the disaster made the disaster more likely.

So, on climate change, both 1 and 2 are true. On the pandemic, 2 (if you define the disaster as the number of people who died during it, which I do) is clearly also true. And, although it may not be a continuing process, none other than the former Chief Scientific Advisor to the UK Government regards another pandemic as “inevitable”.

We have built systems to look at past disasters and, in particular, try and guard against 2. The Covid Inquiry is working its way through the evidence about the pandemic, and has already produced definitive evidence on how we could do things differently for those who wish to read it, but the reporting of its work is patchy, with sometimes unhelpful fixations on the wrong thing.

And denial tends to fight back as our go-to defence mechanism, which is why we often seem to need to have Public Inquiries about the same things again and again and again.

It is all quite normal. That is the problem.

The inequality of redundancy

05. August 2026 · Write a comment · Categories: Actuarial, Birmingham, COVID-19, Economics, Health, Pensions, Science Fiction

In October 2009, while working as a pensions actuary in Birmingham, I attended the Institute and Faculty of Actuaries’ Joining Forces in Mortality and Longevity multidisciplinary conference at the Royal College of Physicians in Edinburgh. The canapés were excellent and, of the plenary speakers, I particularly remember Rudi Westendorp from Leiden University who, in response to the question of whether it was nature or nurture that was responsible for longevity, said it was both.

It was also the first and last time I have used a sleeper train. I had a trustee meeting on the Friday morning south of London and decided that it would be a good idea to get the sleeper from Edinburgh to London on the Thursday night. I hadn’t really researched it in advance and I suppose I was expecting a cabin to myself, but it turned out I was in fact sharing with a German guy who looked like he rode the overnight trains of Europe all the time. There was a set of bunk beds which took up most of the cabin and my memories of that night were of my being thrown around every time the train took a bend down the East Coast mainline, not sleeping a wink while my room-mate snored soundly throughout and then of his taking an annoying amount of time to brush his teeth in the morning. The trustees did not get me at my best.

But I digress. The session from the conference which has stayed with me ever since was by Eugene Milne from Newcastle University. As the blurb for his session A new model of mortality and survival stated:

A new mathematical model mimics patterns of mortality in species from nematodes to humans. Net risk, it suggests, arises from two components, an interactive element accounting for historical falls in human mortality, and redundant decay which shapes lifelong risk. This suggests “intrinsic ageing” is unrelated to the slope of the mortality curve, and is unlikely to have altered for humans in recent centuries.

Eugene Milne went on to become Director of Public Health for Newcastle and took them through the pandemic. The full paper in the British Actuarial Journal from 2009 is here.

At a time where actuarial mortality modelling consisted either of projecting observed trends into the future (with no real explanatory power for observed features like cohort effects) or attempted to project a range of causes of mortality based on the likely progress in treating them (which is limited by the quality of information on death certificates), Milne’s model stood out for starting from a biological model of gradually diminishing redundancy within the body. He recognised its limitations, as he said at the time:

As a bridge between actuarial and biological approaches to ageing it falls, as yet, between two stools. The examples in this paper are generated by probabilistic computer modelling. This is clearly not adequate for
actuarial use and the model needs to be developed further to provide a form that will serve that purpose. On the other hand, it describes (as noted in section 4) a biology that would be ‘needed’ in order to construct organismal risk as it is observed. This it does well, providing a coherent account of why mortality patterns appear as they do. Yet its theoretical ‘biology’ is at odds with currently favoured theories of ageing. If the biological quantity described in the NBM [nested binomial model] as redundancy exists, we do not yet know what it is, nor why it should appear to act in so sequestered and consistent a fashion.

But the idea stayed with me, and perhaps that made me particularly receptive to Richard Murphy’s recent article about allostatis, which he describes as “the way living organisms survive by continually adapting to the changing world around them”. As Murphy points out:

If something breaks, a wealthy person can simply have it repaired or replaced. If travel arrangements fail, alternatives can be found. If income is interrupted, there are savings to draw upon. Problems remain, because they always will, but they rarely threaten the stability of everyday life for a wealthy person. In other words, the amount of adaptation required of them is reduced.

There have been a number of attempts over the years to draw attention to how your level of income affects your ability to adapt to your environment.

In George Orwell’s Down and Out in Paris and London, he describes the effect of poverty:

For, when you are approaching poverty, you make one discovery which outweighs some of the others. You discover boredom and mean complications and the beginnings of hunger, but you also discover the great redeeming feature of poverty: the fact that it annihilates the future.

However Orwell has been criticised, as the temporary tramp that he was, for deciding that meant the end of anxiety. More recently, Jack Monroe used Terry Pratchett’s example of Captain Vimes’ boots, to illustrate how what life costs depended on how much you already had:

A really good pair of leather boots, the sort that would last years and years, cost fifty dollars. This was beyond his pocket and the most he could hope for was an affordable pair of boots costing ten dollars, which might with luck last a year or so before he would need to resort to makeshift cardboard insoles so as to prolong the moment of shelling out another ten dollars.

Therefore over a period of ten years, he might have paid out a hundred dollars on boots, twice as much as the man who could afford fifty dollars up front ten years before. And he would still have wet feet.

Jack developed the Vimes Boots Index to highlight inflation in basic food products, which then persuaded the ONS to launch a shopping prices comparison tool.

But to return to the idea of redundancy: it is clear that if you have, say, redundant money which can be brought in to play when things go wrong, then things generally go much better for you. But imagine if you have used up any redundancy quite some time ago and therefore any reverse is a potential crisis. Your stress levels will be much higher all of the time, as your body tenses for the battles it knows lie ahead about anything from a car that won’t start to a boiler that packs up to a hike in the price of bus fares or the basic food products on the Vimes Boots Index. Day in, day out.

At the moment one of the differentials in redundancy is around heat stress. Housing which cannot be cooled without electricity which cannot be afforded. Day in, day out, for much of the summer so far. But in winter the same housing will need far more heating because its occupants cannot afford capital investment like insulation.

And the reason for this enormous inequality in the level of redundancy, is of course wealth and income inequality. The Equality Trust sets out the statistics as follows:

The UK has very high inequality of income compared to other developed countries; the 9th most unequal incomes of 38 OECD countries (OECD, 2022).

The UK’s wealth inequality is much more severe than income inequality, with the top fifth taking 36% of the country’s income and 63% of the country’s wealth, while the bottom fifth have only 8% of the income and only 0.5% of the wealth according to the Office for National Statistics.

And this stress, day in, day out, means that people also die earlier, as shown below in the House of Commons Library research briefing on Inequalities in life expectancy, using ONS figures (and honestly they’re not picking on Blackpool):

And yet the most likely way for you to hear the word redundancy is when some company is planning to get rid of some of its workforce.

The trouble with people is that you don’t need them until you do, as Jonn Elledge has written here:

There are substantial differences between the US military and the NHS: but what both have in common is that, when they need something, they really do need it. The entire notion of “efficiency” is misplaced.

Similarly, in Nate Hagens’ latest interview, with biologist and biophysicist Olivier Hamant, they explore:

…how cheap, abundant energy allowed human societies to substitute the “safety net” of resource abundance for the safety net that living systems actually rely on: diversity, redundancy, and cooperation.

Until the resources stopped being so abundant.

And then there is the kind of workplace sustained redundancy programmes create, as Seth Godin says in a recent blog post:

“How few people can we get away with?” That’s a question many bosses think hard about. Automate. Streamline. Improve productivity and take humans out of as many tasks as possible. It’s a time-tested way to create profits and to increase a certain kind of reliability. Claude Code is popular with many organizations for precisely this reason.

“How can we include more people into this process?” is a less popular but often more valid way to create value. In an organization that is in the business of bringing insights, humanity and care to problems, more involvement from people creates better outcomes. The challenges make it far more valuable.

Which sort of organization would you like to work for?

And what sort of society do we want to have? One that supports the people in the bottom quintile with no redundant capital, so that they might have the resources available to maintain the stability of everyday life and reduce the adaptation required of them? Or one which keeps demanding more and more from those it allocates less and less of national wealth to. To quote from another Orwell book, Nineteen Eighty-Four, from the mouth of O’Brien, Big Brother’s Grand Inquisitor:

If you want a picture of the future, imagine a boot stamping on a human face—for ever.

I think we can all come up with better pictures of the future than that one.

Professions, triangulation and the costs of adaptation

28. July 2026 · Write a comment · Categories: Climate Change, Economics, Education, Health, Professions

The Charybdis is a swirling water feature in the temperate house at Savill Garden. It was designed by Giles Rayner in 2006. https://funandgames.org/web/wp-content/uploads/2020/09/The-Charybdis_Savill-Gardens_9257-2-scaled.jpg *– you may have recently seen the original in The Odyssey*

Last week I mentioned that I thought this blog, for the rest of the year at least, would be about what we resist, what we create and what we could nurture in the face of a terrifying future. This week I thought I should start to put a bit of flesh on that particular carcass.

One source for my thinking on this is Alex Steffen. I recently attended one of his Personal Climate Strategy: The Basics webinars. He is particularly good on the importance of continually updating your world view in the face of climate discontinuity and increasing evidence of societal brittleness, and how professions can often be a barrier to doing this:

The greatest danger in any work that asks you to think systemically about the future is getting locked into the worldview that made sense to you when you first began, that you built your successful career on.

We all have limited time and energy. Building up an insightful mental model of how the world works takes a lot of both. The pay-off is in the profit and sense of purpose gained from one’s expertise. It is very common, when you’re highly rewarded for a given set of working insights, to commit more to those insights as your career unfolds, to begin even to defend those insights from challenging new perspectives (ones you fear might devalue your intellectual stock in trade). This “sunk-cost expertise” can easily become a set of shackles.

The article then goes on to explain the process of triangulation, by which professionals can “deflate pressure (from the public, regulators or activist stakeholders) to change more quickly and shore up the power of management and experts who would otherwise be forced to admit that they don’t really know what they’re doing”. If someone starts by saying that they support what you are suggesting, then responds with a bunch of short-term easy actions and claims that these are the start of a journey towards what you are suggesting, you are probably being triangulated.

Another is a recent article by Richard Murphy on the political economy of adaptation. As he says:

The biological idea that first made me think this might be possible is called allostasis. It is not a complicated concept. It simply describes the way living organisms survive by continually adapting to the changing world around them.

As we all know, nothing alive exists in a stable environment. Every living thing must continually respond and adapt to changing circumstances. Human beings are no exception. Our brains and bodies are constantly anticipating change and adjusting to it. Most of that work happens without us ever noticing. Allostasis happens all the time, and most of us do not notice. But the fact is that this continual adaptation has a cost.

Murphy points out that, at a time of continual change like ours, that cost is high. And the adaptation required is much higher for people who cannot just throw money at their problems. He then goes on to say:

That changes how we think about political economy. Politics then becomes the process by which societies decide how those costs of adaptation are distributed, whilst economics becomes the study of how institutions either increase or reduce them. Accounting becomes the means by which we identify who ultimately bears the cost of adaptation and health becomes one of the principal ways in which we observe its effects.

I think there is a lot to this approach, which would also provide a structure to identify and critique the triangulation process set out by Steffen. Murphy only mentions education once in this piece:

Education should recognise that human beings learn differently, rather than assuming that everyone should conform to a single model.

I would go a lot further than that, because I think education is the key to helping individuals with their own adaptation strategies as well as in developing the political understanding to see how the costs of adaptation are currently distributed and how to change that within a democratic system. This seems to be an extension of what I have been writing recently about how not to be a reverse-centaur for instance.

The implications for this in health, education and our institutions are considerable in my view and growing all the time. So that is what I am going to be writing about for a while.

Starting next week with allostasis.

Healthy life expectancy is unwell

28. April 2026 · Write a comment · Categories: Actuarial, COVID-19, Demographics, Health, Media & Politics, Pensions, Regulation

*Source: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/datasets/healthstatelifeexpectancyallagesuk*

Yesterday an extraordinary thing happened: the news story about the UK’s falling healthy life expectancy led the BBC News for a while, ahead of the King’s visit to the US in the wake of the assassination attempt on Trump’s team and the latest twists in the Mandelson affair. And so it should: over the decade 2012–14 to 2022–24, healthy life expectancy in the UK fell by about 2 years, to 60.7 years for males and 60.9 years for females.

And that is just the average. As we can see from what I felt was the most informative graphic from the Health Foundation’s report, some of the local authority areas have seen precipitous falls over the same period. Merthyr Tydfil has fallen from 57.6 years to 50.1 years. North Lanarkshire has fallen from 58.3 years to 52.3 years. And in England, Sandwell has fallen from 57.7 years to 51.3 years. In the 2012-14 data, only one region had no local authorities with a healthy life expectancy below the state pension age. By 2022-24, most regions have a healthy life expectancy below 66 years.

Healthy Life Expectancy (HLE) is defined as the number of remaining years that an individual can expect to live in “very good” or “good” general health. Rates of “very good” and “good” general health by sex and five-year age band are captured from the following survey general health question on the Annual Population Survey (APS) and in the Census 2011 and Census 2021:

How is your health in general; would you say it was…

Very good?
Good?
Fair?
Bad?
Very bad?

I last wrote about HLE in 2017 in response to John Cridland’s review of the State Pension Age. My view at that time, when healthy life expectancy was plateauing rather than falling like a stone, was that it was time to consider a universal basic income model. Then only the poorest decile was going to be condemned to 18 years of working in poor health until they could claim a state pension. Now the overall averages in some local authorities have moved down to join them, this consideration appears rather more urgent.

In 2014, I was concerned about what happens if the healthy life expectancy doesn’t increase in line with the planned increases to the State Pension Age and, towed along 10 years behind it, Normal Minimum Pension Age (NMPA). Well here we are: 26 of the little local authority blobs are at or below the current NMPA of 55. This nearly doubles to 49 local authorities (assuming the fall in HLE doesn’t continue, which feels like a heroic assumption at the moment) when the NMPA is due to rise to 57 in April 2028.

As the Health Foundation report says:

While healthy life expectancy has declined, life expectancy has remained broadly stable for the UK overall, indicating that the deterioration is not primarily driven by changes in mortality. However, in more deprived areas, life expectancy remains below pre-pandemic levels, suggesting mortality plays a greater role in reducing healthy life expectancy in these areas. Worsening self-reported health remains a key factor throughout the UK, highlighted by a falling proportion of life spent in good health and by wider evidence of declining health among the working-age population.

Other countries have not experienced this, illustrated by the UK sliding down the international comparison tables:

*Source: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/gho-ghe-hale-healthy-life-expectancy-at-birth*

In the complete table the UK is sandwiched between Puerto Rico and China, with (from World Bank data) GDP per capita respectively of $39,344 and $13,303, compared to the UK’s GDP per capita of $53,246 (all from 2024).

Andrew Mooney, The Health Foundation’s principal data analyst, said: “The UK has the highest levels of obesity in western Europe and there has been a surge in mental ill health, especially among young people.”

Perhaps, instead of obsessing over GDP growth, we should be focusing on what countries like Iceland, Norway, Australia and New Zealand have been doing in recent years to tackle population health. I think it would make us all feel better.

Here we are again

19. March 2026 · Write a comment · Categories: Actuarial, COVID-19, Health, Media & Politics, Professions

I have caught Covid for the third time this week, so naturally my thoughts have turned to how it all began.

There are a few Covid posts starting to turn up online as the 6th anniversary of it all rumbles around. The British Foreign Policy Group have helpfully published a timeline from which I have taken everything that happened before Boris Johnson locked us down for the first time:

So a lot had happened by 23 March. You will all have your favourite bits from the saga above, I think mine is 22 January, when Public Health England announced they had moved the risk level to the general public from very low to low.

I remember teaching a macroeconomics class on 12 March when we knew it was going to be the last session on campus. The penny hadn’t dropped. Students were asking about how they would hand work in. We agreed it would have to be online. Some lecturers were talking about microwaving paper submissions to sterilise them. We had a little giggle about that. I had spoken to Stuart McDonald (now MBE) earlier that day where we had reluctantly agreed to postpone his visit to campus to speak to the Leicester Actuarial Science Society (LASS). Stuart would of course become one of the actuarial stars of the pandemic for his work with the COVID-19 Actuaries Response Group. I had a similar conversation by email with Lord Willetts, who was Chancellor at the University of Leicester at the time and who was going to talk to LASS about his books The Pinch and A University Education. We talked of postponing rather than cancelling. The realisation that everything was changing for the foreseeable future was still not there.

It took a long time for the penny to drop for the Government as well. As this analysis of the establishment of the “Covid Disinformation Ecosystem” says:

January featured fear and disbelief, February proved covid couldn’t simply be ignored, March was when governments realised the hospitalisation rate could overwhelm healthcare.

And a Government that was slow to respond initially was very vulnerable to the groups which sprung up during 2020 and 2021. As the Counter Disinformation Project says:

And the main initial target for the UK section of the ecosystem was Boris Johnson who was meeting privately with newspaper owners and editors. Enough doubt was put into Johnson’s mind that he dithered and delayed when cases began to rise, leading to a private meeting with Heneghan, Gupta and Sweden’s Anders Tegnell in September before he chose to ignore his scientific advisors’ calls for a circuit breaker lockdown. In the run up to the deadliest weeks of the pandemic the papers were calling for Johnson to “Save Christmas’.

However I don’t want to focus on our collective inability to make decisions during crises this time. This time I want to focus on the impact of the pandemic on our mental health.

By coincidence, today the 386 page Module 3 report from the Covid Inquiry on The impact of the Covid-19 pandemic on the healthcare systems of the United Kingdom was published. The longer this Inquiry goes on, the more it appears to resemble a truth and reconciliation commission rather than something likely to improve the handling of future pandemics. It gets past transgressions on the record, but in a way designed to move us on rather than improve our preparedness and organisation. I certainly saw nothing in the summaries that I didn’t already know. Module 3 has made 10 recommendations. The only one which mentions mental health at all is the last one on Psychological and emotional support for healthcare workers.

Looking through the module titles, it would seem that this is unlikely to be rectified until Module 10 – Impact on society – reports, currently scheduled for the first half of 2027. I find this relegation of our collective trauma to the lowest priority astonishing.

Two years ago, the Centre for Mental Health produced a review of the evidence so far on COVID-19 and the Nation’s Mental Health. They noted that:

Data on the prevalence of mental health difficulties is harder to assess. For children and young
people, surveys in England have provided a time series since 2020 that suggests very strongly that
mental ill health is indeed more prevalent now than it was before the start of the pandemic. A steady
rise in the decade prior to 2020 seems to have been followed by a sharp rise, and numbers have
stayed high ever since. We do not have the equivalent data for adults, meaning that a clear picture
has yet to emerge, but there is persuasive evidence that levels of mental ill health have been rising
over the last decade, and the pandemic has contributed to many of the risk factors people face.

Before concluding as follows:

Crucially, the pandemic exposed fault-lines in the nation’s mental health, and the stark inequalities
faced every day by people living with mental illness. The public’s mental health was deteriorating
in the years running up to the pandemic, and mental health services were struggling to deal with
the consequences of many years of underfunding and austerity measures across public services.
People with a mental illness were already dying 15-20 years sooner than the general population, and
facing widespread hardship. The pandemic exacerbated these inequalities, creating new risks to
people’s mental health and reducing access to support.

We now have the opportunity to learn from this experience and build a mentally healthier future.
We can act now to boost the public’s mental health in the aftermath of the pandemic, protecting
those who have experienced the worst effects and offering better support to groups that don’t yet
have access to the right support. And we can incorporate mental health into preparations for future
emergencies, so that responses are psychologically informed from day one.

They also made 10 recommendations, mostly for the NHS and Department for Health and Care, but also covering education, communications and considerations for the upcoming (at the time) review of the Mental Health Act. Less than half of these recommendations have been addressed at all.

Now we are two years on from that report, what has changed?

Well, Roy Lilley has drawn a rather dispiriting picture for us. He draws attention to Wes Streeting’s announcement in the Health Service Journal on 12 March, that the proportion of the NHS budget spent on mental healthcare would be cut for the third year in a row. Lilley lists how the demands on mental health services have mushroomed since before the pandemic:

Around two million people were in touch with mental health services in 2019, today it’s around three million;
Child and Adolescent Services: in 2019 around 500,000 referrals. Now around a million;
And only around 45% of referrals are accepted, meaning the true demand is even higher;
Talking therapies are up by 60%; and
Crisis team referrals and sectioning under the Mental Health Act are also up 60%.

And he summarises the problem like this:

The total economic cost of mental ill-health in England in 2022 was estimated ~£300bn a year when lost productivity, welfare and wider costs are factored in.

The total MH budget is about £16bn. Meaning, the NHS is spending roughly £1 trying to address a £18 national problem.

It feels like we are still waiting for the penny to drop.

Football’s coming home in the worst way

14. January 2026 · Write a comment · Categories: Birmingham, Health, Media & Politics

*The Sun attempts to get a new song going on the terraces. Still not going to be selling newspapers in Liverpool though*

Disclaimer: I support Liverpool FC, so it is entirely possible that the following may be a slightly skewed account of recent football history and its implications.

Last week Manchester United sacked their manager after 14 months. Since Alex Ferguson left in the summer of 2013, United have now had 10 different managers (it was announced this week that Michael Carrick was coming back for a second bash at caretaker manager).

This is despite the fact that it is very difficult to establish whether changing managers helps, with most studies citing how many different factors are at play. One masters dissertation concludes that, although it may produce a short term boost, it is generally not enough to save a club from relegation from the Premier League. So why do it?

Surprisingly this leads us into something called Ritual Scapegoating Theory, first cited at least 60 years ago as a possible explanation for managerial succession in baseball. So changing manager may or may not make much difference to performance, but it does make everyone feel better.

And it may be that the catharsis of sacking a Special One every season or so is making Manchester United supporters feel better than the two FA Cups, two League Cups and a Europa League win (that they have managed in the 13 years since Ferguson left) have. In that time Liverpool, with just three managers, have won two Premier League titles and a Champions League, UEFA Super Cup and Club World Cup as well as an FA Cup and two League Cups. Manchester City, with just two managers in that time, have won seven Premier League titles, a Champions League, UEFA Super Cup and Club World Cup as well as two FA Cups and six League Cups.

In the previous 27 years when Manchester United had just one manager, they won 13 League titles, two Champions Leagues, five FA Cups, four League Cups, and the UEFA Europa League, Super Cup and Cup Winners’ Cup, and the FIFA Club World Cup and the Intercontinental Cup. The lesson Manchester United have learned from this apparently is not that they need to minimise manager turnover.

Chelsea are even worse. They have had 13 different managers over the same period. They sacked the current England manager Thomas Tuchel after just 20 months despite him winning them the UEFA Champions League, Super Cup and Club World Cup. They sacked Enzo Maresca after just 18 months despite him winning them the UEFA Conference League and the Club World Cup. That appears to be catharsis on steroids.

Now this doesn’t matter very much when it is just about baseball or football. Despite what Bill Shankly said, life and death and our politics more generally are much more important than football. My fear is that the view that we need to sack someone whenever we don’t get the result we want immediately is leaching out of football into everything else.

Nigel Farage’s favourite phrase appears to be that “Heads must roll”. He has deployed it about the head of children’s services in Rotherham over three children being removed from their foster families in 2012, the whole of the NatWest board when he was refused a Coutts account in 2023, unspecified individuals from Essex Police managing the demonstrations outside an Epping hotel last year, and also last year again feeling that some head rolling was in order in response to the Government’s national inquiry into grooming gangs.

Meanwhile Kemi Badenoch said in 2024 of civil servants “There is about 5 per cent to 10 per cent of them who are very, very bad. You know, ‘should be in prison’ bad”. Last week she called for the Chief Constable of West Midlands Police to go over the decision to ban fans of Maccabi Tel Aviv from the Aston Villa ground for their Champions League match in November (which, hilariously, now appears to have been, at least partly, influenced by how badly Maccabi Tel Aviv supporters behaved at an entirely fictional game against West Ham United). Also in November, she called for the people involved in making the Panorama documentary about the Capitol Riots, to be sacked (another “heads should roll” headline). Also in November, she decided other BBC “heads must roll” over the decision to uphold complaints and reprimand a newsreader for altering her script from “pregnant people” to “pregnant women” on camera in a piece about groups most at risk during UK heatwaves.

It feels like the footballisation of public life. Farage and Badenoch are routinely reported as furious about something or other, in addition to the frequent demands for sackings, nearly always of public servants. They can clearly see there are votes in it, but the effects of this continuous vilification of public services and the people running them go way beyond that.

The immediate effect is often to make someone’s job untenable. So both the NatWest and Coutts CEOs left after the Farage complaint. The BBC’s Director General and BBC News Chief Executive both left soon after the Badenoch complaint. Now these are all comfortably off individuals who will no doubt be fine, but the impact on an organisation of the idea that any of its leaders could be hounded out at any moment, not through any regulatory process or indeed any process at all, but by someone in politics with a big mouth can be seen increasingly in our public institutions.

One example would be in the NHS. The HSJ recently published an article on the distribution of tenure of trust chief executives (it required four screenshots to show you just how long a tail can be!). Notice how it is not until half way up the 3rd screenshot (counting up from the bottom) that you find a CEO who has been in post for 50 months, and four of them are about to leave.

Source: https://www.hsj.co.uk/leadership/trust-ceos-time-in-post/7040645.article?storyCode=7040645

As Roy Lilley says:

Public reporting over the last eighteen months points to exits by:

NHS England CEO, plus
a cluster of senior national directors exiting.
At least 10 ICB chief executives stepping down or being replaced.
Trust CEO turnover approaching a quarter of posts;
implying 50 or more trust-level departures, including permanent and unplanned exits.

Taken together, a guesstimate is between 60 and 80 chief executives and equivalent senior leaders have left their roles across the NHS in the last eighteen months.

As he goes on to say:

High turnover at the top tells the rest of the system that leadership is temporary. Risk is unrewarded and survival matters more than stewardship.

Authority is put at question.

That encourages short-term-ism, compliance and caution. Precisely the opposite of what complex service reform needs.

For those fans of Manchester United’s way of running things who seem to be running things at the moment, that is a hell of a lot of catharsis. Evidence suggests that it is unlikely to achieve much else.

The catharsis never lasts, as at some point the music has to stop, and someone needs to actually be sitting in actual chairs, actually managing the thing. Just ask Chelsea and Manchester United.

Enshittification and Cory Doctorow

04. December 2025 · Write a comment · Categories: AI, Book reviews, Cartoons, Economics, Health, Legal, Media & Politics, Professions, Regulation, Science Fiction

So this is my 42nd blog post of the year and the 8th where I have referenced Cory Doctorow. Thought it was more to be honest, so influential has he been on my thought, particularly as I have delved deeper into what, how and why the AI Rush is proceeding and what it means for the people exiting universities over the next few years.

Yesterday Cory published a reminder of his book reviews this year. He is an amazing book reviewer. There are 24 on the list this year, and I want to read every one of them on the strength of his reviews alone.

I would like to repay the compliment by reviewing his latest book: Enshittification (the other publication this year – Picks and Shovels – is also well worth your time by the way). Can’t believe this wasn’t the word of the year rather than rage bait, as it explains considerably more about the times we are living in.

I have been a fan of Doctorow for a couple of years now. I had had Walkaway sat on my shelves for a few years before I read it and was immediately enthralled by his tale of a post scarcity future which had still somehow descended into an inter-generational power struggle hellscape. I moved on to the Little Brother books, now being reenacted by Trump with his ICE force in one major US city after another. Followed those up with The Lost Cause, where the teenagers try desperately to bridge the gap across the generations with MAGA people, with tragic results along the way but a grim determination at the end “the surest way to lose is to stop running”. From there I migrated to the Marty Hench thrillers, his non-fiction The Internet Con (which details the argument for interoperability, ie the ability of any platform to interact with another) and his short fiction (I loved Radicalised, not just for the grimly prophetic Radicalised novella in the collection, but also the gleeful insanity of Unauthorised Bread). I highly recommend them all.

I came to Enshittification after reading his Pluralistic blog most days for the last year and a half, so was initially disappointed to find very little new as I started working my way through it. However what the first two parts – The Natural History and The Pathology – are is a patient explanation of the concept of enshittification and how it operates assuming no previous engagement with the term, all in one place.

Enshittifcation, as defined by Cory Doctorow, proceeds as follows:

First, platforms are good to their users.
Then they abuse their users to make things better for their business customers.
Next, they abuse those business customers to claw back all the value for themselves.
Finally, they have become a giant pile of shit.

So far, so familiar. But then I got to Part Three, explaining The Epidemiology of enshittification, and the book took off for me. The erosion of antitrust (what we would call competition) law since Carter. “Antitrust’s Vietnam” (how Robert Bork described the 12 years IBM fought and outspent the US Department of Justice year after year defending their monopolisation case) until Reagan became President. How this led to an opening to develop the operating system for IBM when it entered the personal computer market. How this led to Microsoft, etc. Then how the death of competition also killed Big Tech regulation ( regulating a competitive market which acts against collusion is much easier than regulating one with a small number of big players which absolutely will collude with each other).

And then we get to my favourite chapter of the book “Reverse-Centaurs and Chickenisation”. Any regular reader of this blog will already be familiar with what a reverse centaur is, although Cory has developed a snappy definition in the process of writing this book:

A reverse-centaur is a machine that uses a human to accomplish more than the machine could manage on its own.

And if that isn’t chilling enough for you, the description of the practices of poultry packers and how they control the lives of the nominally self-employed chicken farmers of the US, and how these have now been exported to companies like Amazon and Arise and Uber, should certainly be. The prankster who collected up the bottled piss of the Amazon drivers who weren’t allowed a loo break and resold it on Amazon‘s own platform as “a bitter lemon drink” called Release Energy, which Amazon then recategorised as a beverage without asking for any documentation to prove it was fit to drink and then, when it was so successful it topped their sales chart, rang the prankster up to discuss using Amazon for shipping and fulfillment – this was a rare moment of hilarity in a generally sordid tale of utter exploitation. My favourite bit is when he gets on to the production of his own digital rights management (DRM) free audio versions of his own books.

The central point of the DRM issue is, as Cory puts it, “how perverse DMCA 1201 is”:

If I, as the author, narrator, and investor in an audiobook, allow Amazon to sell you that book and later want to provide you with a tool so you can take your book to a rival platform, I will be committing a felony punishable by a five-year prison sentence and a $500,000 fine.

To put this in perspective: If you were to simply locate this book on a pirate torrent site and download it without paying for it, your penalty under copyright law is substantially less punitive than the penalty I would face for helping you remove the audiobook I made from Amazon’s walled garden. What’s more, if you were to visit a truck stop and shoplift my audiobook on CD from a spinner rack, you would face a significantly lighter penalty for stealing a physical item than I would for providing you with the means to take a copyrighted work that I created and financed out of the Amazon ecosystem. Finally, if you were to hijack the truck that delivers that CD to the truck stop and steal an entire fifty-three-foot trailer full of audiobooks, you would likely face a shorter prison sentence than I would for helping you break the DRM on a title I own.

DMCA1201 is the big break on interoperability. It is the reason, if you have a HP printer, you have to pay $10,000 a gallon for ink or risk committing a criminal offence by “circumventing an access control” (which is the software HP have installed on their printers to stop you using anyone else’s printer cartridges). And the reason for the increasing insistence on computer chips in everything from toasters (see “Unauthorised Bread” for where this could lead) to wheelchairs – so that using them in ways the manufacturer and its shareholders disapprove of becomes illegal.

The one last bastion against enshittification by Big Tech was the tech workers themselves. Then the US tech sector laid off 260,000 workers in 2023 and a further 100,000 in the first half of 2024.

In case you are feeling a little depressed (and hopefully very angry too) at this stage, Part 4 is called The Cure. This details the four forces that can discipline Big Tech and how they can all be revived, namely:

Competition
Regulation
Interoperability
Tech worker power

As Cory concludes the book:

Martin Luther King Jr once said, “It may be true that the law cannot make a man love me, but it can stop him lynching me, and I think that’s pretty important, also.”

And it may be true that the law can’t force corporate sociopaths to conceive of you as a human being entitled to dignity and fair treatment, and not just an ambulatory wallet, a supply of gut bacteria for the immortal colony organism that is a limited liability corporation.

But it can make that exec fear you enough to treat you fairly and afford you dignity, even if he doesn’t think you deserve it.

And I think that’s pretty important.

I was reading Enshittification on the train journey back from Hereford after visiting the Hay Winter Weekend, where I had listened to, amongst others, the oh-I’m-totally-not-working-for-Meta-any-more-but-somehow-haven’t-got-a-single-critical-word-to-say-about-them former Deputy Prime Minister Nick Clegg. While I was on the train, a man across the aisle had taken the decision to conduct a conversation with first Google and then Apple on speaker phone. A particular highlight was him just shouting “no, no, no!” at Google‘s bot trying to give him options. He had already been to the Vodaphone shop that morning and was on his way to an appointment which he couldn’t get at the Apple Store on New Street in Birmingham. He spotted the title of my book and, when I told him what enshittification meant, and how it might make some sense out of the predicament he found himself in, took a photo of the cover.

My feeling is that enshittification goes beyond Big Tech. It is the defining industrial battle of our times. We shouldn’t primarily worry about whether it is coming from the private or the public sector, as enshittification can happen in both places: from hollowing out justice to “paying more for medicines… at the exact moment we can’t afford to pay enough doctors to prescribe them” in the public sector, where we already reside within the Government’s walled garden, to all of the outrages mentioned above and more in the private sector.

The PFI local health hubs set out in last week’s budget take us back to perhaps the ultimate enshittificatory contracts the Government ever entered into, certainly before the pandemic. The Government got locked into 40 year contracts, took all the risk, and all the profit was privatised. The turbo-charging of the original PFI came out of the Blair-Brown government’s mania for keeping capital spending off the balance sheet in defence of Gordon Brown’s “Golden Rule” which has now been replaced by Rachel Reeves’ equally enshittifying fiscal rules. All the profits (or, increasingly, rents, as Doctorow discusses in the chapter on Varoufakis’ concept of Technofeudalism) from turning the offer to shit always seem to end up in the private sector. The battle is against enshittification from both private and, by proxy, via public monopolies.

Enshittification is, ultimately, a positive and empowering book which I strongly recommend you buy, avoiding Amazon if you can. We can have a better internet than this. We can strike a better deal with Big Tech over how we run our lives. But the surest way to lose is to stop running.

And next time a dead-eyed Amazon driver turns up at your door, be nice, they are probably having a worse day than you are.

Again and again and again

27. November 2025 · Write a comment · Categories: Economics, Health, Media & Politics

On 20 November, the UK Covid-19 Inquiry published its second report and recommendations following its investigation into ‘Core decision-making and political governance’. The following day these were the headlines:

This contrasts with the Inquiry’s first report and recommendations following its investigation into the UK’s ‘Resilience and preparedness (Module 1)’ on Thursday 18 July 2024. Then the following day’s headlines looked like this:

Whereas the first report had recommended a radical simplification of the civil emergency preparedness and resilience systems, including:

A new approach to risk assessment;
A new UK-wide approach to the development of strategy, which learns lessons from the past;
Better systems of data collection and sharing in advance of future pandemics;
Holding a UK-wide pandemic response exercise at least every three years and publishing the outcome; and
The creation of a single, independent statutory body responsible for whole system preparedness and response.

The second report on the other hand merely reran the pandemic, pointing out where we went wrong on:

The emergence of Covid-19;
The first UK-wide lockdown;
Exiting the first lockdown;
The second wave; and
The vaccination rollout and Delta and Omicron variants.

And crucially who to blame for it. Its recommendations were far less specific and actionable in my view than those from the first report. And yet it got all the headlines, with glowering images of Baroness Hallett and pictures of Boris Johnson with head bowed.

The first report dealt with what we could do better next time and was virtually ignored (only The Daily Mirror and The Independent carried “They failed us all” headlines about the Covid Inquiry first report). The second dealt with who to blame and it dominated the headlines. I think this neatly encapsulates what is wrong with us as a country and why we never seem to be able to learn from our own past mistakes or the examples of other countries.

This is not about defending Boris Johnson or any of his ministers. It is about realising that they are much less important than our own ability to sort out our problems and study any evidence we can to help us do that.

The NHS suffers from the same problem, as Roy Lilley has described here, too many inquiries and most of their recommendations ignored. Again and again and again. We choose to focus on the minor and irrelevant at the expenses of the major and important. Again and again and again. As Lilley says:

Until we make it OK for people to say… I made a mistake… we will forever be trapped in a Kafka world of inquiries coming to the same conclusions…

…If inquiries worked, we’d have the safest healthcare system in the world.

Instead, we have a system addicted to investigating itself and forgetting the answers.

It is part of a pattern repeated yesterday, focusing on the micro when our problems are macro. Rachel Reeves increased taxes by £26 billion in yesterday’s budget, which was much less than the £40 billion in her first budget, and yet still led to the BBC reporting “Reeves chooses to tax big and spend big” and the FT leading with “Rachel Reeves’ Budget raises UK tax take to all-time high“, and with this graph:

This is hilariously at odds with the message of what it was reporting last week:

The latter was obviously an attempt to head off a wealth tax, which appears to have been largely successful. Our averageness when it comes to tax, though, is supported by this graph using OECD data from Tax Policy Associates:

Our position in the middle of the pack will be little affected by what happened yesterday. And that and all the chatter about the OBR leaking it all an hour in advance rather drowned out the fact that there was relatively little additional spending (around £12 billion overall, a quarter of which was on the welcome removal of the two-child limit). The main point was to increase our “fiscal headroom” to £22 billion, ie the amount the Government can spend before they breach their own fiscal rules.

It looks like we are going to do what we are going to do, with fiscal headroom management masquerading as economic policy, and otherwise just sit around waiting for the next disaster. Which we will then have a big inquiry about to tell us that we weren’t remotely prepared for it. Which we will then ignore…and so it continues. Again and again and again.

Boxes

24. October 2025 · Write a comment · Categories: Actuarial, Birmingham, COVID-19, Health, Legal, Media & Politics, Regulation, Risk

*The warehouse at the end of* *Raiders of the Lost Ark*

In the year when I was born, Malvina Reynolds recorded a song called Little Boxes when she was a year younger than I am now. If you haven’t heard it before, you can listen to it here. You might want to listen to it while you read the rest of this.

I remember the first time I felt panic during the pandemic. It was a couple of months in, we had been working very hard: to put our teaching processes online, consulting widely about appropriate remote assessments and getting agreement from the Institute and Faculty of Actuaries (IFoA) for our suggested approach at Leicester, checking in with our students, some of who had become very isolated as a result of lockdowns, and a million other things. I was just sitting at my kitchen table and suddenly I felt tears welling up and I was unable to speak without my voice breaking down. It happened at intervals after that, usually during a quiet moment when I, consciously or unconsciously, had a moment to reflect on the enormity of what was going on. I could never point to anything specific that triggered it, but I do know that it has been a permanent change about me, and that my emotions have been very much closer to the surface ever since. I felt something similar again this morning.

What is going on? Well I haven’t been able to answer that satisfactorily until now, but recently I read an article by David Runciman in the LRB from nine years ago when Donald Trump got elected POTUS the first time. I am not sure that everything in the article has withstood the test of time, but in it Runciman makes the case for Trump being the result of the people wanting “Trump to shake up a system that they also expected to shield them from the recklessness of a man like Trump.”. And this part looks prophetic:

[Trump is]…the bluntest of instruments, indiscriminately shaking the foundations with nothing to offer by way of support. Under these conditions, the likeliest response is for the grown-ups in the room to hunker down, waiting for the storm to pass. While they do, politics atrophies and necessary change is put off by the overriding imperative of avoiding systemic collapse. The understandable desire to keep the tanks off the streets and the cashpoints open gets in the way of tackling the long-term threats we face. Fake disruption followed by institutional paralysis, and all the while the real dangers continue to mount. Ultimately, that is how democracy ends.

And it suddenly hit me that this was something I had indeed taken for granted my whole life until the pandemic came along. The only thing that had ever looked like toppling society itself was the prospect of a nuclear war. Otherwise it seemed that our political system was hard to change and impossible to kill.

And then the pandemic came along and we saw government national and local digging mass graves and then filling them in again and setting aside vast arenas for people to die in before quietly closing them again. Rationing of food and other essentials was left to the supermarkets to administer, as were the massive snaking socially-distanced queues around their car parks. Seemingly arbitrary sets of rules suddenly started appearing at intervals about how and when we were allowed to leave the house and what we were allowed to do when out, and also how many people we could have in our houses and where they were allowed to come from. Most businesses were shut and their employees put on the government’s payroll. We learned which of us were key workers and spent a lot of time worrying about how we could protect the NHS, who we clapped every Thursday. It was hard to maintain the illusion that society still provided solid ground under our feet, particularly if we didn’t have jobs which could be moved online. Whoever you were you had to look down at some point, and I think now that I was having my Wile E. Coyote moment.

The trouble is, once you have looked down, it is hard to put that back in a box. At least I thought so, although there seems to have been a lot of putting things in boxes going on over the last few years. The UK Covid-19 Inquiry has made itself available online via a YouTube channel, but you might have thought that a Today at the Inquiry slot on terrestrial TV would have been more appropriate, not just covering it when famous people are attending. What we do know is that Patrick Vallance, Chief Scientific Advisor throughout the pandemic, has said that another pandemic is “absolutely inevitable” and that “we are not ready yet” for such an eventuality. Instead we have been busily shutting that particular box.

The biggest box of course is climate change. We have created a really big box for that called the IPCC. As the climate conferences migrate to ever more unapologetic petro-states, protestors are criminalised and imprisoned and emissions continue to rise, the box for this is doing a lot of work.

And then there are all the NHS boxes. As Roy Lilley notes:

If inquiries worked, we’d have the safest healthcare system in the world. Instead, we have a system addicted to investigating itself and forgetting the answers.

But perhaps the days of the box are numbered. The box Keir Starmer constructed to contain the anger about grooming gangs which the previous 7 year long box had been unable to completely envelop also now appears to be on the edge of collapse. And the Prime Minister himself was the one expressing outrage when a perfectly normal British box, versions of which had been giving authority to policing decisions since at least the Local Government (Review of Decisions) Act 2015 (although the original push to develop such systems stemmed from the Hillsborough and Heysel disasters in 1989 and 1985 respectively) suddenly didn’t make the decision he was obviously expecting. That box now appears to be heading for recycling if Reform UK come to power, which is, of course, rather difficult to do in Birmingham at the moment.

But what is the alternative to the boxes? At the moment it does not look like it involves confronting our problems any more directly. As Runciman reflected on the second Trump inauguration:

Poor Obama had to sit there on Monday and witness the mistaking of absolutism for principle and spectacle for politics. I don’t think Trump mistakes them – he doesn’t care enough to mind what passes for what. But the people in the audience who got up and applauded throughout his speech – as Biden and Harris and the Clintons and the Bushes remained glumly in their seats – have mistaken them. They think they will reap the rewards of what follows. But they will also pay the price.

David Allen Green’s recent post on BlueSky appears to summarise our position relative to that of the United States very well:

We Know Zero