Just the beginning of a dynamic healthcare experience
_{by Leonie Rushforth}

I recently received an email invitation to attend a special meeting of members of the Homerton University Hospital Foundation Trust.

The invitation came from the Trust Secretary but didn’t contain a link to the meeting I was being invited to attend. Instead I was directed to click on a link leading to a second more detailed letter from the same Trust Secretary, which asked me to follow a link to the Council of Governors website page and scroll until I found the registration link.

Why had this been made a little more difficult than it need have been? What was the purpose of the first email, signed by the Trust Secretary – under the umbrella of Civica Election Services (formerly Electoral Reform Services) a subsidiary of Civica Engagement Solutions. CES is a company helping the Homerton Trust, ‘build and support engaged communities’ by providing ‘patient & public engagement software’.

According to Civica’s website, they are the leading provider of patient and public engagement software for the public and health sector in the UK, on whose behalf they ‘securely hold over 2.2 million member and stakeholder records’:
‘Civica Involve, our digital community and stakeholder engagement platform, makes it simple to build beautiful engagement websites, create effective surveys, and analyse real-time data to inform your decision-making and service delivery. Supporting customers across the public sector, our smart engagement platform helps you increase community participation and understand the feedback you receive.

The equation is a simple one: community participation = one-way feedback = data collection and my data as a stakeholding Trust Member has been collected.

***

Civica Engagement’s ‘partners’ include the Patient Experience Network (PEN) and text-analytics platform Pansensic.

Pansensic ‘turns your consumer, employee and society text feedback into data-driven insights for improvement and growth’. They promise Sentiment Analysis and Emotion Analytics. They like the word ‘capture’. According to Pansensic, the ‘NHS’ (no name, no position, no department) had this to say about their service:
'Very few organisations in the world have the capability to make sense of customer and staff comments in any volume and to be able to use it to drive improvement or innovation. Pansensic has led to an exponential increase in this rich qualitative data collected by the NHS and helped us design better healthcare for our patients’ (NHS)

The not-for-profit, membership-based Patient Experience Network is concerned to help everyone involved ‘in delivering the patient experience’. This includes the NHS, Civica and the inevitable SERCO. Their core activity appears to be selling their PEN approval logo to members for a fee of £10,000.

PEN’s Managing Director, Ruth Evans is an active Twitter user. Her account is more or less a chain of links to articles on telehealth – a term we’re all engaged with in practice now we have to consult our doctors remotely whether we like it or not. In February Ms Evans tweeted a link to an article posted on the ‘strategy+business’ website. The article, ’Empowerment will be at the heart of the new healthcare experience’, is authored by three employees of PwC, one of the Big Four accounting firms; all three are involved in building its ‘health services arm’. Their opening assertion that patients need to be enabled to take care of the management of their own health leads unsurprisingly and pretty quickly to ‘telemedicine’. Specifically the article focuses on the development of wearable devices capable of relaying information on the likelihood of hospital readmissions – information of considerable interest to insurance companies:
'Social determinants of health have a significant impact on well-being. For example, a faith-based health system in the midwestern United States is working with a Fortune 500 technology company to factor social determinants of health into determining the likelihood that certain patients discharged from the hospital will be readmitted. These societal influences can help answer basic questions such as:

• Can the patient adhere to what he or she is being asked to do?
• Does the patient live alone or does he or she have a live-in or external support system?
• Is the patient within walking distance of a gym?
• Does the patient have access to healthy food?

The authors go on to envisage a time when a young woman on a ‘pregnancy journey’ might receive ‘push notifications’ or unsolicited personal advice direct to her phone, but it won’t necessarily be medical advice:
‘The pregnancy journey is a promising example of how the empowering healthcare tools that are being developed today might shape the future of the patient and caregiver experience. After a baby is born, the journey continues, after all. Health systems that can evaluate a mother’s online search history, for example, or call up her and her child’s previously recorded health records, could send push notifications to the mother’s mobile phone, reminding her of any tests or health interventions her child might need or alerting her to discounts available on products or services that might be helpful to her.’

***

Civica Group is for accounting purposes known as Camelia Investments 1, whose financial statements for 2020 state they are majority owned by funds managed by Partners Group, a private markets investment manager with $94 billion of assets.

Camelia’s directors include amongst their experience employment at BAE Systems, Goldman Sachs, TSB - and PwC. One of the markets they identify in their 2020 report as of future priority interest is democracy.

The meeting of the Homerton Trust was attended by a record 78 Trust members. They voted down proposals that would have radically reduced the involvement of local people in future decision-making by the Trust’s board, who on this occasion as on every other had their ducks in a row and were expecting a good performance of stakeholder engagement – but had not anticipated mobilisation in defence of non-marketable democracy at a level that would cost them the vote.

Submission to the Special Legislative Committee on reforming Canada’s Police Act: Part 2
_{by Samir Gandesha}

My personal encounters with the police as well as my observations of policing behaviours during APEC, the G20 Summit as well as during the 2010 Olympics, Gustafson Lake as well as Burnaby Mountain and the on-going situation on Wet’suwet’en territories, lead me to pose serious questions about whether the public good is being properly “served” and “protected” by law enforcement ­– as currently constituted – in this province in particular but this also of course extends to the country as a whole.

History teaches us that unless the weakest and most vulnerable members are safe and secure in our society, then, at the end of the day, no citizen is.

I would like to emphasize that my personal interactions with the police have not been uniformly negative; far from it. Despite certain unpleasant early experiences, I therefore possess no particular animus towards law enforcement. I do not view individual police officers through a moral lens, as either “good” or “bad,” but, rather, regard them just as just ordinary persons, like you and I, simply doing their jobs according to their training and to the best of their ability.

However, at the same time, as part of this training – as with the armed forces (see Gwynne Dyer’s excellent 1985 documentary Anyone’s Son Will Do) – police officers are socialized into roles that often entail maintaining rather than dismantling myriad systems of oppression and structural violence.

Our emphasis ought to be precisely on these roles individuals are required to play. This is an important point because it casts doubt on the idea that making law enforcement more “diverse” is – on its own – to meaningfully reform policing.

The idea is that if police forces more closely resemble the communities they police, such forces will do so in a fairer and more just manner than if they did not.

I believe that such an assumption while, on the face of it reasonable and intuitive, would not necessarily stand up to the scrutiny of critical judgment in light of empirical evidence.

Individual racialized persons can, themselves, also uphold norms and structures of white supremacy, just as – we must never forget – individual white people can work energetically and constructively towards its dismantling. The issue is not just black and white.

So, as I have already said, I see my role here today as one of posing questions. Such questions include but are not limited to the following:

• Is the purpose of policing really to serve and to protect the public? Or is it to serve and protect the wealthy, powerful and influential? Who, in fact, is included in and who is excluded from the dominant definition and image of the “public?”
• Is the purpose of policing to enforce the laws in an egalitarian and genuinely democratic order or is it to maintain existing forms of socio-economic inequality, hierarchy and social exclusion that undermines the egalitarian foundations of such a democratic order?
• Is the purpose of policing to support and help build up communities or is it to tear them down either by commission (i.e. police brutality), or omission (i.e. the withholding or withdrawal of resources)?
• Is it the role of law enforcement’s leadership to challenge the structures of settler colonialism, white supremacy, white privilege, racism and sexism more generally? Or is it to reinforce such structures? One cannot, for example, dismantle systemic racism if one denies its existence.

Many of my Indigenous colleagues, associates and friends are steadfastly committed to the view that policing as currently constituted is a function of settler colonialism. Insofar as they are working actively and energetically to dismantle settler colonialism, and also for the advent of genuine nation-to-nation relations, many Indigenous peoples are also committed to the abolition of law enforcement, at least as we know it. As the OISE academic, Professor Rinaldo Walcott, has recently reminded us in his book on property, the demand for the abolition of the police is historically tied to the first demand for abolition on this continent, namely: for the abolition of the institution of slavery.

Indigenous peoples (like many in the black community) are deeply skeptical of the very possibility of police reform. And who can blame them?

But the demand to “Defund the police” that we hear from many quarters after the death of George Floyd, isn’t simply about decreasing funding for law enforcement. Rather, as philosopher, writer and long-time civil rights activist, Angela Davis, recently stated:

“It’s about shifting public funds to new services and new institutions – mental health counselors, who can respond to people who are in crisis without arms. It’s about shifting funding to education, to housing, to recreation. All of these things help to create security and safety. It’s about learning that safety, safeguarded by violence, is not really safety” (Democracy Now! Sept 07, 2020).

For the sake of argument, let’s say that police reform is both (i) a possibility and (ii) worth pursuing. What might such reform look like?

Street opera during lockdown II
_{by Iain Galbraith}

You may remember talk of the Sardinian Viceroy Saint-Rémy's nightmare of pestilence and of Antonin Artaud's description in 1938 of how a plague thrusts "inflammatory images" into "our unexpectedly alert minds"? – well, the story continues with somebody studying the minutiae of a woman's appearance on a tram. Overcome by the sight of her right ear the observer cannot accept that such incredible qualities do not have a voice of their own. With so much to proclaim, how can they keep it to themselves? But how could they do otherwise? the reader will ask. It is quite enough that the woman is whatever she is. If the details of her appearance or composure really were to find the right words, her shoe or a loose strand of her plaited hair would need to utter them. But that was more than a hundred years ago. Today we have learned that all things speak when the time is right.

Meanwhile, as the tram passes, I pull the curtain aside and look again into the street below, where the intensity of extraction has risen to an intolerable pitch. The window is open and while I am watching, a man appears with a gun and forces the workers to form a line in front of a ditch. They look at the ground. The man demands they explain to him why they are digging. The road has been dug up 17 times in the last 5 years and he cannot tolerate it any longer. (I know him, a neighbour who lives two houses down on the left. The noise drives him round the bend, so he tells me, but this is the only time I have seen a gun in his hands).

Only one of the workers can speak the language. He doesn't know the answer. The man should ask the foreman who gives them their orders, but he is not here now. They only do what they are told. They drill and dig and fill. About 30 yards down the road a young man sits slumped on a chair. What's with him? The worker replies that he has been like that since yesterday, and has not lifted a finger. Blue lights flash, the police restrain the gunman, the ambulance removes the young man, the foreman, back at the site now, cautions the workers to continue filling the ditch.

They fill. They do not speak. When the earth was young and studded with volcanoes, pieces of rock the size of Mont Blanc might fall into the lava and form a plug. It must have been a sight to behold. The unfathomable pressure that formed the volcanoes did not diminish then, but could spread for hundreds of miles before finding another outlet. That distance has grown shorter ever since, which lends evidence to what science already knows: the planet's crust, which once had an insulating function, has grown significantly thinner.

Like in the movies
^{by Christos Tombras}

Early last year I offered a thought experiment involving a demon and a lotto jackpot. What if, I asked, on your way to play your lotto numbers, a demon appeared to you claiming he knows the numbers you were going to play? What if he handed you an envelope with the numbers he claimed you were going to play? What would you do? Would you check the envelope? Would you change your numbers?

The thought experiment was regarding free will. What is the content of free will, it invited us to think, if a demon can have knowledge of our choices even before we have actually made them ourselves? I concluded by saying that the mere existence of a prediction regarding a future choice would affect the phenomenon under observation in a way that would render the prediction irrelevant.

But was this all?

***

Let us revisit the experiment. First, let us consider the demon. He appears to me and claims he has knowledge about my numbers. He does not explain how he does the trick. Is he able to follow the inner workings of my mind? Does this mean that the inner workings of my mind evolve along specific pathways that can be mapped and traced in any direction the demon sees fit? Should we conceive the timeline of all events as already laid out on some film that starts from a past and reaches the future? If so, then the present would be nothing more than a small window through which we can see the contents of the frames of the film come to life. Like in the movies.

The demon, then, would be like the projector operator, who has the whole film at his disposal and knows where it starts and where it ends.

Alternatively, we could think of the demon as being able to exist both within and without time. We could picture him as simply being able visit a future moment when I would have already played the numbers, take a note, and then jump back to the present, to hand me the envelope.

Two scenarios that are similar but not identical.

In the first, past, present and future are somehow already set, with no reference to the demon’s whims. This world would be like Laplace’s. The demon, qua observing intellect, would just need sufficient information, and then, all the history of the world, past, present and future, would be available to him. In such a scenario free will simply doesn’t exist.

In the alternative view, a demon can travel to the future, observe a state of affairs, and come back to the present with information about that future state of affairs. We no longer need to think that present past and future are already set in any specific way. Free will is salvaged. Our time travelling demon does not present any threat to it. He can have a knowledge of our choices because he looks at us standing in the future – in much the same way that we can have a knowledge of the past, because we look at it standing in the present.

***

Things seem settled, until we recall the little problem regarding the history of the world that we spoke about last time: There can never be a true and complete history of the world, we concluded, because there is no place one can stand on to speak about what we see. We are always a part of the reflection, a part of the picture we try to capture.

What about our demon then? Where can he be located?

A serious problem presents itself to us. Can the demon be outside time, free from any time constraints, able to travel back and forth from the future, and still be able to be inside time, able to interact with me and my lucky lotto numbers?

That’s tricky.

For what we try to picture is a demon who can both be a subject of time – in the sense that he is able to record and relay information, as well as interact with other beings of our world – and also be beyond and above time, presumably operating in ways we cannot even begin to fathom. There is an antinomy here. The main problem can be located in the very way we combine concepts in order to form the question. It is as if we are trying to conceptualise a rectangular circle. Think about it for a second. How can this be? A rectangular circle. It’s not a matter of imagination. You simply cannot have it both ways. It’s either circular or rectangular. End of story.

Similarly, at the exact moment that you will try to envisage a demon marching up and down the timeline of a world, all world-related and time-subjected notions – such as information, communication, or interaction –, all collapse away.

Like in the movie, where the spectators of the film are able to interact with the actors playing in it. It’s a nice plot idea and it can work brilliantly, as Woody Allen showed in his 1985 Purple Rose of Cairo.

But it can only work there, in a movie.

What is misogyny?
_{by Rosemary Bechler}

_{“All of a sudden, I heard what we were saying and blurted out, ‘Wait, I’ve just heard how we’re talking – Only thirty million! Only thirty million human beings killed instantly?’ Silence fell upon the room. Nobody said a word. They didn’t even look at me. It was awful. I felt like a woman.”}

^{A physicist modelling nuclear ‘counterforce attacks’ with defence colleagues, as quoted in Carol Cohn’s contribution to Gendering War Talk, ed., M Cooke and A. Woolacott, Princeton University Press, 1993. p227.}

I first wrote briefly about misogyny in the context of the 2018 World Cup, and attempts to anticipate and prevent the significant peaks in domestic abuse occurring immediately after an England match. Researchers into successive World Cup finals had found that domestic abuse reports went up by 26% when the England team won a game, and anything up to 38% when they lost, incidents increasing in frequency with each new tournament. I was writing about masculinity and the augmented sense of power involved in identifying with the National Us. Police explanations at the time were confined to a combination of “alcohol and tension” and the increased testosterone associated with higher levels of competitiveness. But, with the honourable exception of the powerful poster designed by the National Campaign against Domestic Violence for the 2018 tournament, the missing term in the dominant discourse on this at the time was ‘misogyny’.

Alongside identification, another basic process of identity formation took my attention, projection. Laplanche and Pontalis in their dictionary of psychoanalytic terms, define projection as the operation whereby “qualities, feelings, [or] wishes, . . . which the subject refuses to recognize or rejects in himself, are expelled from the self and located in another person or thing.” Could misogyny be an example of this, albeit complicated by desire, where the weakness or ‘the loser’ of the woman within oneself is projected onto the woman, who then appears as a returning threat? Added to the basic insights of gender analysts: that gender is not a character attribute, but a social relationship; and that gender structures are socially constructed, historically variable and upheld through the power relations that legitimise them – it seemed to me that advances could and should be made in understanding this dangerous phenomenon far better.

Fast forward to March this year, after a year of pandemic lockdown and gathering concern about a second pandemic of domestic abuse. The abduction and killing of 33-year old marketing executive, Sarah Everard, while she was walking home in south London on March 3, was tragically not at all unprecedented. True, the accused is a Metropolitan Police officer. But what is really remarkable about this horrible death is the outpouring of sympathetic grief across the nation in response, unleashing from women of all ages, but particularly young women, the desire to share with each other in unparalleled numbers the experiences of sexual harassment, degradation, trolling and stalking which have afflicted so many of them. The political class and the media have been forced to recognise that they have another potential George Floyd moment on their hands – a shock to the everyday system we take for granted whose ripple effects force us to interrogate some of the basic motors of our culture. They will try to contain the outpourings. Will they succeed?

They will be up against intrepid young feminist researchers like Laura Bates, whose Everyday Sexism project, begun in 2011, encouraged tens of thousands of women of all ages to speak out online, to show the world that sexism, serious or minor, is “suffered by women every day and that it is a valid problem to discuss.” I only became aware of this “huge phenomenon” last September thanks to Jenny Murray’s extraordinary Woman’s Hour interview with Bates, then launching her latest book on the internet manosphere and its links with the alt-right and white supremacists, Men Who Hate Women: From incels to pickup artists, the truth about extreme misogyny and how it affects us all. In a direct ripple effect, they will be up against the many courageous current and former pupils of UK schools and colleges, including some of the most elite independent schools, who have been flocking to Everyone’s Invited to anonymously record their testimonies about a youth culture that encourages boys to “rate and rank” the bodies of their female colleagues as an introduction to a “rape culture”.

I hope these outpourings build inexorably until we have much better answers to several questions beyond the obvious ones about online pornography and social media. Firstly, what is the link between misogyny and “competitiveness” – not just sports competitiveness, but everyday capitalist competition and the rise of ‘winner-take–all’ logics, the rising fear of being ‘a loser’ that brutalises neoliberal societies today? Secondly, why does mainstream fictional entertainment rely so disproportionately on the abuse and killing of women for its thrills? Lastly, what is the effect of all those war films, war games and war toys, not to mention wars? We will honour Sarah Everard’s memory if the women and girls who are now posing these questions for our time, and the men and boys who care for them, begin to find the answers that we all need. Jacqueline Rose’s well-timed new book, On Violence and on Violence against Women, is eagerly awaited.