Month: October 2016

Dear George 6

23rd October 2016


Dear George,

Yes, yes, dear chap, I’m still here, and you should be as well. I can’t tell just how lovely the sunsets are especially after a decent G and T by the poolside. I could really get to like this. By the way, did you get your chaps to see to the mess in your hallway after that particularly foul issue with the sewage outflow? It must have been quite a bore to have been contacted in the middle of night at your little ‘pied a terre’ in Knightsbridge to then to be told that there was a pretty rank smell in your house in, which one is it now? Oh, never mind…and worse, that Boris was not to to blame this time.

Couldn’t resist that little joke.

I hear St Theresa is getting little miffed with the Troika she set up to handle the negotiations for, you know what. Well what did she expect? Her decision was akin to letting loose three starving dogs in a butcher’s shop and then expecting them to conjure up a Beef Wellington good enough for Heston fucking Blumenthal’s great Aunt Bessy (she of the Yorkshire puddings). Yes they know about meat, but they are hardly likely to go about the business with any finesse, forethought or familiarity with common decency. There will be blood, most of it theirs as they gorge on what remains of the sausage called the British Economy. I hear the Bank’s trade union spokesman is bluffing on about them taking their cash to the gnomes of Frankfurt or some other ghastly place. Her Saintedness had better get round there quick, flash a bit of tit, and make sure the bastards stay put. Christ the hours you and I spent in wining and dining the c*nts, for that is what they will be if they now desert you all in your hour of need. I lost count of the number of dinner jackets my chaps had to pop down to Savile Row to replace, and the interminal caviar stains like adolescent jizz down my shirt front. Not often I feel cheap as you know old boy, but by Eton’s fell waters, they could spend. I remember one chap, don’t remember if it was Chase, JP’s or Goldman’s, telling about buying a nice little property in Scotland for the weekend shooting. I thought he meant a country pile, like Sam’s pater’s, but bugger me he meant Perth and Kinross. All in secret of course, couldn’t let the Sweaties know. Bought it off a chap from China after a thrilling game of ‘chase the monkey’ in Gleneagles.

I didn’t know monkeys would wear gimp masks, but what do I know? Funny what you pick up at dinners in the City.

Well I hope she’s happy. Phil ‘face like slapped tit’ Hammond is the only one in the whole bloody outfit who has the slightest clue whats going on, but he is as about as affective as a row of daisies grown especially for stopping a panzer division on their way to a ‘lets kick the shit out of anything in our way festival’ during the glory days of the blitzkrieg. The troika will tie him up in knots and whip his testicles till they bleed his heart dry. They’ll have fun doing it while the City turns the currency into shite where the pound is worth no more than a polo (mint – not the car).

Sam’s preparing tonight’s dinner. Thankfully she brought the decent caterers with her this time, you know the ones. So the fizz is on ice, the oysters shucked and I’m on a promise methinks.

You really must pop over, I hear old Pip Green is at a loose end and might be in need of cheering up. Perhaps he’ll lend you that Lear he keeps near Windsor, tell him the wine is rather good, even over here.

Pip pip,


PS. Boris asked for demonstrators outside the Russian embassy, I assume he sold his shares in Gazprom then?

Dear George 5

16th October 2016


Dear George,

The sun is still shining over here, my word it is rather splendid. Why oh why did we not organise a few more jollies in this direction instead of shlepping it over to Frau Merkel’s in the sodding rain of a damp February morning? I’m sure the Maldivians would have been interested in hearing about our plans to adapt to climate change, what with most of their land being lower than the ethical standards of Trump in a brothel. Speaking of whom, the fillies here are rather, well, suitably pleasing on the eye in that dusky way of theirs. I don’t mind telling you, a rather pretty little thing brought breakfast this morning and I have to confess, I rather thought of a decent spanking, but not the sort we were used to back in the old days? Gosh, I do think the sun is rather working havoc with the old hormones.

So whats up with Blighty now that St. Theresa’s been given the keys to the money ‘printing presses’? I know you never believed that bullshit about austerity, but I think her blessed Saintness did not get the irony in cabinet when we talked about budget deficit reduction. I should have known that her blank face was not due to a lack of sense of humour, although God knows she is about as much fun as one’s morning ablutions following a hot chilli wings competition in Walsall, no it was because…and bugger me with a pineapple, she was taking us seriously when we said “there is no money”. Christ, what the blue fuck does she think money actually is? Does she think the Treasury is stuffed to the gunnels with dubloons, shekels and gold sovereigns? Did she really believe that to bail out the NHS you have to actually go running down Whitehall with a wheelbarrow stuffed full of gold coins to Richmond House like some demented Pirate in a Treasure burying race in which the loser donates a still attached testicle to a rabies crazed crocodile? Its one of the few things I’ll regret in leaving office. We should have made it clearer we were only joking, it seems we should have spelled it out. Austerity was for keeping the plebs in check, not for putting one’s granny out on the street because some tosser in a local authority paid the rent for a jihadi inclined immigrant in Barking (or some such). No more money for the NHS? What! You must be livid. We were always going to bail out the NHS, but you were keeping that until 2020.

Weren’t you?

Perhaps we are getting her all wrong, perhaps its the same tactic. Scare the living bejesus out of the lower orders and then pull it out, rabbit like, just before the next election?  I just was saying to one of the medics Sam and I employ just the other day, that all would be well with the NHS. The poor would always be looked after. Granted, they might have to wait a bit longer in AE and for cancer care…but not all cancers are quick killers anyway. A bit of wait would do some of them good. They’d get a sense of the value they are getting for free as they wait and reflect on what damn fine value is the NHS. Rupert (M…not old Prince Rupert zu Loewenstein who sadly passed away – god he could throw a bash) says the middle classes like to use insurance anyway. We do so as a matter of course for just about everything else, so its just a bit of molly coddling that they need to be weaned off.

Like a piglet off a teat.

Except we should use a taser to their gonads to do the job. Sometimes I fucking hate the middle class. At least the working class know they are swivel eyed goonbuckets with a penchant for a supersize bucket of KFC, duty free cigarettes and celebrity wankfests passed off as chat shows, dancing and the culinary arts which feature handling a bag of flour and a whisk as the summit of their pathetic achievement (don’t tell Sam I said that, chuffed to bits when she won of course, but its not international diplomacy, nuclear physics or organising an orgy in a nunnery for the over sixties celebrant). The middle class? Fuck ‘em. You know those country suppers back in old Chipping Norton? We had fun with Jezzer and Tony (before that little incident on Top Gear involving a steak, baby oil and a well greased dildo). I always thought Cherie came across as bit of jumped up middle class tart, y’know the sort. Called to the Bar, and thinks she’s mother bloody Theresa (the dead one, not her blessed saintliness now at the helm).

Oh, I know you won’t tell, but my chap found this headed paper in my luggage as he unpacked. Shame to waste it. Hilary’s emails? Now thats a piss take.

Pip pip,


PS. Boris. The bastard, I always knew he’d written two very different articles on Brexit. Et Tu Boris? Whats latin for ‘Cunt’?

Dear George (4)

13th October 2016



Dear George,


How are you old chap? I’m sitting here, toes in the pool, and warming my bones in the jolly old Maldivian sun, and just as the second plop of the ice in the G and T settles, I think of dear old you.


I note that the “Torygraph”, I know I shouldn’t but I do still giggle at that, is putting it about that you’ve gone to ground, not been seen since, well you know, and that a sighting of you is as rare as an oiled up spanking in St Theresa’s inner office. So ‘whats’s up’ (as they say in Brixton).


Has ‘Madame La Garde’ offered you a post at the IMF, has the World Bank called? Did those nice chaps from Beijing come through with that ‘investment’? I bumped into Tony on my way here, sends his regards by the way, and among the commiserations on the result he slipped in a mention of that directorship if your still interested? Cherie gave him a hard stare at that but I know who wears the trousers in that relationship. So, give him a call, you’ve still got his number? If not, call my people, I’ll let them know its you. I’ve had to field any number of crank calls recently so use the password: ‘Brexit’.


I always chuckle at that.


Well, nearly always.


I can’t tell you what a relief its been to leave all the hurly burly behind in London. Sam’s much happier now that’s there’s no need to ‘meet and greet’ the great unwashed. Smiling in public was never her forte, never had a need to before I got the top job. At Smythson’s, her talent for luxury was well suited, never a need to kowtow to nobodies. It was in her genes of course, Charles 2nd being an ancestor and Daddy being the 8th baronet of somewhere probably northern. I did feel for her having to smile and nod politely at number 10 tea parties as some blatherer spouted on about the deficit (not you of course!) or the colour of monkeys. Mind you, I don’t mind telling you (no names, no pack drill) that all that pent up frustration was taken out rather positively on my downstairs department later.


So, what’s new? Well I can’t tell you how lovely the sunsets are here. Remember that bash we had with Pip Green on his boat offshore at Monaco? You know, the night Cliff was caught with his trousers down with one of Bill and Melinda’s valets? Just being a ‘bachelor boy on holiday’ was his excuse. Anyway, the two of us were up on top deck alone, watching the setting sun, softly singing “jolly boating weather” when all of a sudden the peace was broken suddenly and loudly by the sound of a bucket of vomit spilling into the swimming pool below. You bet me a tenner it was Prince Andrew who we’d last seen face down, clutching a bottle of fizz, in the lap of a rather exquisite ‘model’ behind the lifeboats. How we laughed when we saw it was actually old pip himself, buck naked skinny dipping, doing back stroke, his old todger in full view the size of rain soaked maggot, only smaller. No wonder Mrs Pip gets a decent bonus from the BHS business. I bet that’s the only way he can now satisfy her.


Oh, how we laughed.


How we laughed.


Back then.


Righto. Old chap must dash, the fizz doesn’t open itself and Sam is getting a bit, well y’know.


Happy days!


Pip pip,




ps Boris? She’s taking the piss.

Climate change is an unsolvable wicked social problem?

Climate change is an unsolvable wicked social problem?



The following outline of climate change as a wicked problem (Rittel and Weber 1973) is based on a reading of Reinar Grundmann’s (2016) ‘Focus on Climate change and the social sciences’. The work of Jurgen Habermas (1984, 1987) and Wolfgang Streeck (2016) contextualises the exposition of climate change as a wicked social problem and this paper agrees with Grundmann’s analysis that there are no easy answers for the short or medium term, here defined as within 50 years, and adds that perhaps there might not ever be. Thus we are adopting Gramscian ‘pessimism of the intellect’ which requires urgent work on adaptation for a very different and perhaps dystopian world by the end of the century.


Regardless of its genesis, whether that be human induced or natural cycles, climate change requires human responses. Mitigation is now probably too late, as we’ve in all likelihood passed 400 ppm of carbon dioxide permanently. This means we are locked into temperature rises above the 2 degree ‘safe’ level. This is taking us into a new era, the Anthropocene, beyond a ‘safe operating space for humanity (Rockstrom et al 2009). Therefore we will have to plan for, and more urgently talk about, adaptation, disaster management and conflict resolution. However and in what manner we come together, or not, to address the fact of climate change and all of the other ecological challenges, this a ‘wicked social problem’ exacerbated by contemporary changes in the geopolitical, social and technological order (Streeck 2016, Harari 2016). The Anthropocene may well be characterised as a period of insecurity, indeterminancy and dissipation of the social order into a miasma of dystopia. Human societies are experiencing the dialectic between risks arising from modernity and the solutions put forward to manage those risks (Beck 1986).


A wicked problem is the sort of problem that is inherently different from the sort of ‘tame’ problems that natural scientists and engineers grapple with.


First of all, ‘wicked social problems’ are never solved once and for all. They can only be better managed. Each ‘solution’ invokes another problem to address. Take, for example, crime. To achieve a society with a 0% crime rate involves either redefining what crime is, leaving unsolved the social problems certain activities previously defined as ‘crime’ invokes, or it requires an enormous and deep level of surveillance and loss of liberty that would have unintended consequences for human relationships and politics. Like a game of ‘whack a mole’ other social, political and philosophical problems would arise from such an answer.


A ‘tame’ problem would be an equation to solve, analysing a chemical compound, designing a bridge or checkmate in 5 moves (Grundmann 2016). Tame problems allow us to know what the measure of success is when they are solved, and success criteria are known beforehand. They have a ‘stopping rule’. The success criteria of wicked problems like crime are inherently political and often underpinned by cultural values within a power matrix of vested interests.


‘Wicked’ here means resistance to solution rather than evil. The problem is difficult to solve because of incomplete, contradictory and changing elements to them that are also difficult to recognise. The elements making up a wicked problem may be interdependent within a complex system and thus solving one element may exacerbate another aspect of the system and/or reveal another problem.


For climate change what are the ‘success criteria’? What indicators, metrics, outcomes or empirical observations can we make that allows us to claim success? This may depend on how we define climate change. Do we use the United Nations Framework Convention on Climate Change (UNFCCC) or the Intergovernmental Panel on Climate Change (IPCC) definitions (Grundmann 2016)?


The UNFCCC define it as “a change of climate that is attributed directly or indirectly to human activity, that alters the composition of the global atmosphere, and that is in addition to natural climate variability over comparable time periods”.


The IPCC define it as “any change in climate over time whether due to natural variability or as a result of human activity”.


The UNFCCC focuses on human activity driving climate change, while leaving to one side natural variability. The IPCC encompasses both. Therefore climate policy would address anthropogenesis (UNFCCC) or everything (IPCC). In each case we would still need to construct measures of ‘success’.


If we could agree and state that the measure is ppm of C02 in the atmosphere then action would naturally be channelled towards addressing that figure. It is by no means clear that this would or could ‘solve’ the social problem of climate change such actions might entail. Climate change does not have a ‘stopping rule’ characteristic of tame problems. Atmospheric Carbon Dioxide might look like one but there are other measures such as carbon budgets, global average warming temperatures or heat content in the oceans. There is also fierce resistance to curbing carbon emissions and environmental regulation in some quarters based on free market and libertarian arguments (e.g. Cato Institute 2016), despite the agreement signed at COP21 in Paris in 2015.



The wider context in which climate change solutions operate.


The expression of climate change as a problem, and climate change solutions, interact with the social, cultural and political power context in which they operate. They are not ontologically separate from the social or the material and they operate within complex adaptive systems. Knowledge/power discourses frame their expression, their feasibility and their acceptability within often hegemonic, though not unchallenged, frames of reference.


That context is variously called late modernity, post modernity, post industrial, disorganised, financial, rentier, or neoliberal capitalism. Wolfgang Streeck (2016) pace Antonio Gramsci, suggests this context is actually a post-capitalist interregnum in which the old system is dying but a new social order cannot yet be born. Streeck calls the current order one of multi-morbidity, climate change being one of many frailties as we head towards social entropy, radical uncertainty and indeterminancy. Streeck argues that the current context is anchored in a variety of interconnected developments:


  1. Intensification of distributional (capital v labour) conflict due to declining growth
  2. Rising social inequality
  3. Vanishing macroeconomic manageability
  4. Steadily increasing indebtedness (private and sovereign)
  5. Pumped up money supply (from quantitative easing)
  6. Possibility of another financial crisis as per 2008
  7. The suspension of democracy
  8. Slowdown of social progress
  9. Rising Oligarchy and Plutocracy
  10. Governments’ inability to limit the commodification of labour, money or nature
  11. Omnipresence of corruption
  12. Intensified competition in winner takes all markets
  13. Unlimited opportunities for self enrichment (for the 1%)
  14. Erosion of public goods and infrastructure
  15. The failure of the US to establish a stable global order
  16. Public cynicism towards economics and politics.
  17. Rising populist nationalism and the spectre of fascism and isolationism in the US
  18. Fracturing political blocs and alliances
  19. Erosion of Democratic legitimacy ad thus a democratic deficit



To that:


  1. Health Inequalities.
  2. Potential Ecosystem collapse.
  3. Disruptive technologies: Automation, Artificial Intelligence and digitalisation.



There are countervailing voices. There are those who see a better future for humanity, placing belief in progress (Norberg 2016), reducing global violence (Pinker 2011), the ability of growth based capitalism to solve problems (Ben-Ami 2010, Goklany 2007, 2009) and the citing of improvements in key indicators such as reductions in infant mortality (see Hans Rosling’s ‘gapminder’ 2016). Added to this are of course the voices of politicians who promise to either “make America great again” , “A country that works for everyone” or “Russia as a Normal Great Power”. Extrapolating from the past into the future is of course inductive logic and is thus open to its critique. This also applies to the negative descriptions of the current state of affairs. The task remains to consider which view will prove correct? Not an easy question partly due to many issues being wicked problems.


These latter political narratives may be examples of ‘systematic distorted communication’, i.e. voices and discourses aimed at achieving very particular political ends inimicable to that aimed towards mutual understanding and social integration. This form of communication, according to Habermas (1984, 1987), involves one party being self deceived, it is a form of communication in which power differentials operate and are invisible.


For example, the Cato Institute argues on environmental regulation:


“Science can inform individual preferences but cannot resolve environmental conflicts. Environmental goods and services, to the greatest extent possible, should be treated like other goods and services in the marketplace. People should be free to secure their preferences about the consumption of environmental goods such as clean air or clean water regardless of whether some scientists think such preferences are legitimate or not. Likewise, people should be free, to the greatest extent possible, to make decisions consistent with their own risk tolerances regardless of scientific or even public opinion”.


On the face of it who would argue against freedom to decide one’s own risk tolerance? ‘Freedom’ is a public good is it not? What this statement ignores is the fact that some very powerful and well resourced ‘others’ are more ‘free’ to exercise risk tolerance, they are also more ‘free’ to engage in activities that involve ‘externalities’ – pushing the cost of one’s exercise of freedom onto others. How free were the victims of Union Carbide’s Bhopal ‘death by negligence’ of 1984 where at least 2000 died as a result of the plant’s gas leak? Union Carbide’s freedom to operate involved a power imbalance that denied the citizens from exercising their ‘risk tolerance’. How free are Londoners in exercising their ‘risk tolerance’ to nitrous oxide pollution from vehicle exhausts responsible for 9,500 deaths per year (Vaughan 2015)?


The Cato Institute argues it is a research organisation conducting independent non partisan research on a range of policy issues. It clearly states however that principles of individual liberty, limited government, free markets and peace underpin its work. Apart from the nebulous ‘peace’ (who is not for peace?), those principles are very clearly part of the neoliberal imaginary and are thus as ideological and partisan as many other organisations. On funding, Cato states on its home page that it receives ‘no government funding’. What it fails to clarify is who exactly funds it. On page 41 of its 2016 annual report there are only numbers of $ donated while preferring to refer to individuals, corporate and foundations as funding streams. However, Cato was founded by the Koch brothers, billionaire owners of Koch industries, who reportedly believe in lowering corporate and personal taxes, minimal social security and less oversight of industry (Mayer 2010). Hardly a non partisan viewpoint.



Habermas’ theory suggests that communicative action serves to transmit and renew cultural knowledge, in a process of achieving mutual understandings. It then coordinates action towards social integration and solidarity. Communicative action is also the process through which people form their identities. The current context suggests that communicative action, orientated towards the requirement for social integration for action on climate change, is extremely fragile.


Gross (2010) gave three examples of systematic distorted communication:


  1. The pervasive employment of Nazi language in Europe in the 1930’s in Europe.
  2. The everyday, routine use of sexist language.
  3. The prescription languages and practices of Physicians influenced by drug company promotions.


We may consider also:


  1. The narrative on individual responsibility for health
  2. The absolute requirement for deficit and debt reduction as a goal of policy
  3. Free market liberalism in the US and the UK
  4. An unaffordable NHS in the UK
  5. Immigration, asylum and refugee control
  6. Fossil fuel subsidies and continued extraction.
  7. The hegemonic Nuclear Deterrence Theory
  8. Koch brothers support for the Cato Institute on liberty, small government and free markets.



Climate change solutions arise and operate within this context. Today we have no easy solutions or even signposts that indicate success on progress to either mitigation or adaptation. It may even be the case that we are actually chasing rainbows. If we are entering a period where social institutions are breaking down, where system integration disappears leaving a mass of individuals to find individual solutions to the myriad problems they face, without grand integrative narratives to provide guidance, then social cohesion breaks down and Habermasian ‘communicative action’ dissipates in the face of the onslaught from the systematic distorted communication of power interests.



Beck U (1986) Risk Society. Towards a new Modernity. London Sage. (1992 edition)


Ben-Ami, D. (2010) Ferrari’s for All – In defence of economic progress. University of Bristol. Policy Press.


Cato Institute (2016) Environmental Regulation (online) accessed 13th October 2016


Goklany I (2007) The Improving State of the World: Why we are living longer, healthier, more comfortable lives on a cleaner Planet. Washington. Cato Institute


Goklany I. (2009) Is climate change the “defining challenge of our age”? Energy Environment, 20:279-302.


Gross A (2010) Systematically Distorted Communication: An Impediment to Social and Political Change. Informal Logic 30 (4): 335-360


Grundmann R (2016) ‘Focus on Climate change and the social sciences’ .


Habermas J (1984) Theory of Communicative Action. Vol 1. Reason and the Rationality of Society. Cambridge. Polity Press


Habermas J (1987) Theory of Communicative Action Vol 2. Lifeworld and System. A critique of Functionalist Reason. Cambridge. Polity Press.


Harari Y (2016) Homo Deus. A brief History of Tomorrow. London Vintage.


Mayer J (2010) Covert Operations. The billionaire brothers waging a war against Obama. New Yorker. August 30th. Online accessed 13th October 2016


Norberg J (2016) Progress. Ten reasons to look forward to the future. London Oneworld.


Pinker S (2011) The better angels of our nature. A history of violence and humanity. London. Penguin.


Rittell,H. and Weber, M. (1973) Dilemmas in a General Theory of Planning, pp. 155–169, Policy Sciences, Vol. 4, Elsevier Scientific Publishing Company, Amsterdam


Rockstrom, J., Steffen, W., Noone, K., Persson, A., Chapin, F. S., III, Lambin, E. F., Lenton, T. M., Scheffer, M., Folke, C., Schellnhuber, H. J., Nykvist, B., de Wit, C. A., Hughes, T., van der Leeuw, S., Rodhe, H., Sorlin, S., Snyder, P. K., Costanza, R., Svedin, U., Falkenmark, M., Karlberg, L., Corell, R. W., Fabry, V. J., Hansen, J., Walker, B., Liverman, D., Richardson, K., Crutzen, P. & Foley, J. A. (2009) ‘A safe operating space for humanity’. Nature, 461 (7263). pp 472.

Rosling H (2016) MDG 4 Reducing Child Mortality available at accessed 13th October 2016


Streeck W (2016) The post-capitalist interregnum: the old system is dying, but a new social order cannot yet be born. Juncture 23 (2): 68-77


Vaughan A (2015) Nearly 9,500 people die each year in London because of air pollution. The Guardian (online) 15th July accessed 13th october 2016

Antonio Gramsci on intellectual thought – challenging nursing.

Antonio Gramsci on intellectual thought – challenging nursing.



Antonio Gramsci (1891-1937), leader of the Italian Communist party, was arrested and imprisoned by the fascist regime in 1926 and died in the Quisisana clinic in Rome in 1937, aged 47. His pre prison work and his ‘prison notebooks’ have hugely contributed to the examination and development of political philosophy and intellectual thought. Among the ideas he developed are the role of the intellectual in culture and politics and the concept of hegemony. The prosecutor at his trial was acutely aware of his intellectual abilities, and thus threat, and stated:


“We must prevent this brain from functioning for twenty years.”


(Buttigeig 2011 p16).


Gramsci found himself in a concrete prison not of his own choosing. Nurses find themselves in an abstract prison of the mind put there by their own reason, their lifeworld colonised by the systematic distorted communication of the strategic action of powerful others.


This is all a world away from the daily work of nursing, and so at first pass may appear of interest only to the likes of critical social scientists or historians of political thought. Reading Gramsci opens up a discussion on what being an intellectual might mean and of how power is exercised and maintained. Nurses going about their clinical work will not be vexed by such questions and it might be the case that academic nurses will not be either. That could be a mistake given the current context outlined by Streek (2016) of global challenges to social order which have current and future impacts on health and health care delivery.


That context is variously called late modernity, post modernity, post industrial, disorganised, financial, rentier, or neoliberal capitalism. Wolfgang Streeck (2016) echoing Gramsci, suggests this context is actually a post-capitalist interregnum in which the old system is dying but a new social order cannot yet be born. Streeck calls the current order one of multi-morbidity, climate change being one of many frailties as we head towards social entropy, radical uncertainty and indeterminancy. Streeck argues that the current context is anchored in a variety of interconnected developments:


  1. Intensification of distributional (capital v labour) conflict due to declining growth.
  2. Rising social inequality.
  3. Vanishing macroeconomic manageability.
  4. Steadily increasing indebtedness (private and sovereign).
  5. Pumped up money supply (from quantitative easing).
  6. Possibility of another financial crisis as per 2008.
  7. The suspension of democracy.
  8. Slowdown of social progress.
  9. Rising Oligarchy and Plutocracy.
  10. Governments’ inability to limit the commodification of labour, money or nature.
  11. Omnipresence of corruption.
  12. Intensified competition in winner takes all markets.
  13. Unlimited opportunities for self enrichment (for the 1%).
  14. Erosion of public goods and infrastructure.
  15. The failure of the US to establish a stable global order.
  16. Public cynicism towards economics and politics.
  17. Rising populist nationalism and the spectre of fascism and isolationism in the US.
  18. Fracturing political blocs and alliances.
  19. Erosion of Democratic legitimacy and thus a democratic deficit.



To that:


  1. Health Inequalities.
  2. Potential Ecosystem collapse.
  3. Disruptive technologies: Automation, Artificial Intelligence and digitalisation.



Streeck seems to suggest that it is the very success of neoliberal capitalism, its defeat of social democracy and forces that would otherwise tame its destructive tendencies, that has paved the way for such developments that characterise its internal contradictions. There is nothing left to save capitalism from itself.


There are countervailing voices such as Joseph Norberg (on the possibility and actuality of progress), Daniel Ben-Ami (on growth based capitalism to solve ecological problems) and Stephen Pinker (on reducing levels of global violence) who paint more positive pictures. Add of course the voices of politicians who promise to ‘Make America Great Again’, to create “A country that works for everyone’ or establish ‘Russia as a Normal Great Power’ or to regain ‘primacy in South East Asia after a century of humiliation’. The picture now is one of complexity, tension, dynamics and unpredictability.


None of this bothers most UK nurses who work with individuals who are ill, distressed, living with long term conditions, or dying in hospital and at home. They are also involved in public health basing their approaches in general health management, health education and health promotion. Their training and education focuses on instrumental competency based knowledge and skill acquisition but it lacks critical enquiry into the context in which they work. Gramsci’s approach to intellectual enquiry could provide a blueprint for alternative or complementary critical nurse education that has to consider wider socio-political determinants of health, the sort of developments that Streeck outlines.




Gramsci’s thinking


We get an insight into how Gramsci’s brain functioned from a letter he wrote in 1929 to the wife of a comrade who also was in prison for ‘anti-fascist’ activity. The context is that of how to study while in prison. The prison referred to, of course, had concrete existence. However, if we consider that today nurses may imprison themselves within the conceptual walls of stultifying paradigms that block freedom of critical thought, for example biomedical empiricism, his thoughts on reflection and analysis might be useful. The letter predates Wright Mills’ 1959 chapter on intellectual craftsmanship, a reading of which shows some commonality in approach and is an alternative to the metrics used today in our research excellence framework assessments. One wonders if Gramsci was writing today, would he secure tenure in some contemporary Universities.


He wrote in the letter that one must abandon, in the prison context, the ‘scholastic mentality’ and banish the thought of pursuing a regular and in depth course of study. Along with Wright Mills who later wrote about avoiding empirical work if he could help it as it was merely about sorting out facts and disagreements about facts, this statement appears to be counter intuitive until one considers that a goal of intellectual life could be about criticality, understanding philosophy, self, culture, history, politics and society. Again put this way, many nurses may well eschew intellectual enquiry as irrelevant.


Gramsci urged language learning as rewarding, but more interestingly is his outlook on the relative paucity of texts in prison libraries. He argued that a political prisoner must extract “blood from stones” (Buttigeig 2011 p15). The paucity of books in prison was of course a function of the external constraints imposed by the regime. The ‘paucity of books’ available to students today may be a result not of external concrete constraints but of internal self imposed constraints as to what counts as proper reading for a degree in Nursing. Gramsci experienced a concrete prison of walls imposed by the fascist regime. We might experience a ‘prison of the mind’ constructed by dominant cultural ideas (hegemony) imposed by ourselves upon ourselves through the process of normative governmentality. Gramsci argued for ‘extracting blood from stones’, the stones being whatever he could get.


To get the most of the books available to him, often popular novels, Gramsci adopted the following viewpoint:


“Why is this always the most read and most published literature?”

“What needs does it satisfy?”


“What aspirations does it respond to?”


“What sentiments and views are represented in these awful books that have such broad appeal?”


For student nurses, these questions could be applied to many of the texts, for example the professional body’s literature, that they read to assist with the development of critical thinking. Critique could be emancipatory but in actuality reading ends up in uncritical acceptance. I’m not talking about appraising and critiquing research evidence or engaging in critical analysis of for example leadership theories in nursing. Criticality is lacking in the socio-political and power domain.

An example of the lack of such criticality is the almost universal acceptance of the UK’s Nursing and Midwifery Council’s revalidation process. The requirement is for nurses to renew their registration every three years by following the process outlined by the NMC. The surface reason for revalidation is that it ‘promotes greater professionalism among nurses and midwives and also improves the quality of care that patients receive by encouraging reflection on practice against the revised code’. If we apply Gramsci’s questions above to the texts on revalidation put out by the NMC, a possibility arises that we just might make alternative and critical analyses of just such banal statements in official publications.


“Why is the NMC always the most read and most published literature on professional behaviour?” Because of its statutory position as the regulator to protect the public. Because Nurse educators use it as the basis for their teaching. Because the NMC has the power to discipline nurses…..

“What needs does it satisfy?” Neophyte nurses, especially, need guidance on professional behaviour and standards and don’t have the time, or resources or educational preparation to consider this in an in depth way. NMC guidance provides the generally widely accepted standard……


“What aspirations does it respond to?” To keep one’s registration and to bolster one’s subject position as ‘safe practitioner’


“What sentiments and views are represented in these awful books that have such broad appeal?” The sentiment of nursing as ‘character based moral work’, of nurses as ‘caregivers’, as self sacrificial angels who always cope……


The answers to the 4 questions of course are myriad and those above are merely some examples requiring further reflection, reflexivity and criticism.


The lack of critique of the NMC on revalidation illustrates ‘normative governmentality’, in that nurses and midwives, and perhaps more interestingly nursing academics, have internalised certain norms, values and assumptions that prevent them from seeing anything other than the official line. This could be an example of what Furedi (2006) refers to as philistinism underpinned by instrumentalism in higher education, in which academics become educational technocrats rather than what Gramsci refers to as organic intellectuals.


Intellectuals are those with broad reading, vision and a concern for public issues. Graham Scambler argues intellectuals are not only engaged in the public sphere but do so around an identifiable moral or political position. A question arises about the degree nurses and midwives are, or wish to be, engaged in moral and political questions, the degree to which they can engage in communicative action free from systematic distorted communication.


The questioning of texts exemplifies the Gramscian notion of critical enquiry and action and allows us to consider such questions as, for example, what counts as research in contemporary nursing faculties. The answer to that is political in that it frames what nurse academics study, write about and publish, and it frames what students of nursing count as valid knowledge. If we apply those questions to the published outputs of contemporary nursing scholarship what answers would we get? For example, does a high h index always indicate intellectual rigour or criticality? Given the wider determinants of health, which include the social, political and ecological, it could be suggested that health care professionals would be aided in their understanding of health and illness, and hence what to do about it, by critical enquiry that goes beyond accepted epistemologies.


Nursing students have been told to be critical thinkers and many University curricula claim to foster such thought. Texts are not to be accepted at face value, and that we should examine assumptions and viewpoints of writers. This should go beyond for example appraising research literature for methodological rigour. Should we also appraise the metaparadigms and epistemological assumptions of ‘acceptable’ and ‘REFable’ nursing research? Should we ask what degree does contemporary scholarship in nursing reflect the sort of intellectual enquiry that Gramsci and Wright Mills advocate? In a world increasingly characterised by forces that threaten to disrupt stability and global order in ways that could be catastrophic to human health, are we preparing nurses to face that?


Gramsci died far too soon, and ‘without honour in his own country’. Whether he considered his life a failure in that fascism still held power, nonetheless he provides a template for thinking, studying and critique in difficult circumstances. He had a vision, he was an intellectual, he had a political purpose. Whether academic nurses in the 21st century find this inspiring or irrelevant may depend on what vision we have for nursing praxis for the future.




Buttigeig J (2011) in Gramsci A (1975) Prison Notebooks. Volume 1 Ed. Einaudi G. Columbia University Press. New York.


Furedi F (2006) Where have all the intellectuals gone? Confronting 21st Century Philistinism. Continuum.


Gramsci A. (1975) Prison Notebooks. Vos 1-3. Edited Einaudi G. Columbia University Books New York.


Scambler G (2013) What is an intellectual?


Streeck W (2016) The post-capitalist interregnum: the old system is dying, but a new social order cannot yet be born. Juncture 23 (2): 68-77



This manifesto calls for a social movement for political activism by nurses and other health professionals, to address inequalities in health and the social inequalities that highly structure, but do not determine, health outcomes. This action can operate at individual, clinical, organisational, national and international level.

Our aim is to respond to threats to health and socialised health service delivery from corporate, financial and political interests.

Our vision is for decreasing social and health inequalities in which the social gradient is greatly diminished.

Our goal is to create a networked social movement involving political and civic activism to bring critical understanding and action into the public sphere.


A Manifesto for Action Nursing

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