The UK Covid-19 Inquiry on Adult Social Care: Residents, Families, Staff and the Costs of Not Listening

In The Guardian today was an article by Jessica Murray, “UK government failures led to Covid spreading ‘like wildfire’ in care homes, inquiry finds.” It is based on a report  ‘Module 6: Care Sector,’ just released by the Rt Hon the Baroness Hallett DBE, as part of the UK COVID-19 Inquiry.

For those of us who work in and around healthcare workforce resilience, the report on adult social care is very much welcomed. It provides an important and careful account of what happened to people receiving care, their families and staff. Those who conducted the Inquiry and contributed evidence, particularly those revisiting painful experiences, deserve real thanks. 

Its findings matter. The Inquiry concludes that care homes were too often treated as an afterthought, that the drive to protect hospital capacity came at considerable cost to social care, and that failures around testing, PPE, hospital discharge and infection control contributed to devastating consequences for residents and their families. “More than 43,000 people died from Covid-19 in UK care homes between March 2020 and July 2022” (⁠The Guardian).

It is also important that the report recognises what happened to staff. Care workers were trying to hold an already fragile system together amid staff shortages, inadequate PPE, rapidly changing guidance and extraordinary personal risk. The Inquiry evidence describes a workforce that was already understaffed, underpaid and undervalued before the pandemic. (⁠The Guardian)

But there is a difficult question that needs to sit alongside the findings. Who working anywhere near social care at the time did not know that something was going badly wrong?

That is not the same as saying that everyone knew precisely what should have been done, or that the evidence available then was as clear as it is now. It wasn’t. But many of the central problems were being raised, repeatedly, by people working in the sector, families, professional organisations and others trying to get decision makers to listen. The fragility of social care was hardly a secret. Indeed, my reading of the evidence submitted to the UK COVID-19 Inquiry is that it was already well known to those working in and caring for people in the sector.

For many people, then, the report will not simply reveal what went wrong. It will formally recognise things many were desperately trying to say while they were happening.

And that matters because inquiries cannot only be about identifying failures retrospectively.

The harder question is what we change so that the next time people working inside a system are saying, 'Something is seriously wrong here!', it does not require years and a public inquiry before those concerns acquire authority.

What mechanisms will ensure that frontline staff are heard? How will social care have a meaningful voice alongside the NHS in an emergency? How will concerns move quickly enough from workers, residents and families to those making national decisions? And how will we know that anyone is actually listening?

Those seem to me to be among the most important lessons still to learn.

What can a South African orange teach us about the entanglement of just transitions?

I recently returned home to the UK from two weeks in South Africa. When I got back, I posted a bunch of photographs to a group chat back in the States.

The photographs were a mixture of everything we had been doing – from enjoying local wineries and going on a game drive to visiting museums and hiking along the Western Cape.

The focus of the visit, however, was work: I had been working with colleagues at Nelson Mandela University and the University of Cape Town on a variety of topics, from AI and complexity to environmental health, urban sustainability, and just transitions. Some of that work took us into parts of Gqeberha and Cape Town where poverty and inequality are very real. But we also saw people and organisations doing remarkable things in response. At Masifunde Learner Development in Walmer Township, for example, we visited their Montessori pre-school, Changemaker Academy and kasiConomy hub, an incubator supporting young entrepreneurs. 

So my group chat started asking questions and we got talking about South Africa.

At some point, one of the group, who lives in Ohio (USA), looked at the orange he was eating and realised it had come from South Africa.

That was a bit of a lightbulb moment.

Here we were talking about South Africa, looking at photographs and discussing what I had been doing, and suddenly the country wasn't quite so far away. There was a South African orange sitting in his hand.

I thought that was a win.

So I added that the blueberries I was eating back in the UK were also from South Africa.

An orange in Ohio. Blueberries in Britain. Both from South Africa.

Another in the group chat – who lives along the northwest coast of the States – was immediately critical: ‘That orange has a serious carbon footprint!’

My family member eating the orange pushed back: ‘Relative to what? Oranges from other places in the States or from the world, all being hawked at various times during the annual commercial distribution period in Ohio.’

I liked the word 'hawked.'

There is something important buried in that little group chat exchange. But my concern went beyond simple carbon accounting.

We had just spent all this time talking about South Africa. About universities and townships. Poverty and inequality. Businesses and employment. Education and community organisations. Vineyards and restaurants. Cities and coastlines. And, most importantly, about people.

One person in the group chat had suddenly looked at an orange and seen his connection to all of that.

Then, almost immediately, the other person reduced the orange to its carbon footprint.

The carbon matters. Of course it does.

But where had South Africa gone?

Rethinking Just Transitions

 

I think this little exchange captures something I have been struggling with in my work on just transitions.

We tend to see just transitions through the particular part of the world we know and the particular problems we have learned to see. Sometimes we become so confident that we are making the environmentally ethical choice that we don't notice how narrow our view of the system has become.

South Africa -> long distance -> carbon emissions -> environmental harm

That is real.

But distance is not the whole story.

An orange’s environmental impact is built across the whole supply chain. It depends on how much water and energy are used to grow it, what chemicals are applied, how it is packed, how long it is refrigerated or stored, and whether it travels by ship, truck or air. The environmental cost comes from all of those things together, not from transport alone. You cannot infer the environmental impact of an orange simply from how far it has travelled.

And then there are the people behind that orange. The same orange held in the hand by a person in Ohio is entangled within a global network of agriculture, workers, household incomes, communities, international trade, land, water, inequality, economic security, and Western consumption demands. In South Africa, citrus is not some marginal part of its economy. According to South Africa's Department of Agriculture, the country exported 2.9 million tons of citrus in 2025, overtaking Spain to become the world's largest citrus exporter by volume that year. (For more, CLICK HERE).

Those numbers represent real people and real economic wellbeing: people picking fruit, sorting and packing it, maintaining farms and equipment, and moving produce through ports. Those jobs mean wages flowing into households and communities. What happens to an export industry of this scale reaches far beyond the balance sheet of a citrus company.

But we shouldn't romanticise that either.

Jobs do not automatically equal justice. Like much large-scale commercial agriculture, the citrus industry depends heavily on seasonal labour and is shaped by mechanisation, insecure employment and unequal bargaining power. Creating jobs does not mean workers necessarily receive a fair share of the value they create.

So ‘Citrus creates jobs, therefore buy South African oranges’ is not a satisfactory answer. But neither is ‘That orange travelled a long way, therefore don't buy it.’

It is not an ‘either/or’ situation. It is ‘both/and’ – and this is my main point: the orange is simultaneously part of an environmental system, an employment system, a food system, a trade system and a development system. Pull on one part of that system and something else moves. If a consumer in a wealthy country decides not to buy the South African orange because of its carbon footprint, that decision does not end at the supermarket checkout. Multiply that decision thousands or millions of times and its effects travel backwards through the supply chain – through retailers, importers, shipping companies, ports, packhouses and farms – eventually reaching workers and communities whose livelihoods have become tied to that export economy.

So what is the answer, then?

This is where I find backcasting particularly useful.

 

Backcasting Just Transitions

 

Most of the time, the questions we ask around environmental impact are framed within the system we already have: should someone in the States buy the South African orange or not? That turns a complex transition into a binary consumer choice: buy the orange and accept its environmental impacts, or don't buy it and accept whatever social and economic consequences may follow.

Backcasting starts somewhere else. Instead of asking which choice to make within the present system, it asks us to imagine the future we actually want and then work backwards to ask what would have to change to get there.

In the case of the South African orange, for example, we might ask: how can we create a global supply chain for citrus that is environmentally sustainable, economically viable and more equitable?

That question gives us a picture of the future we want: one in which South African citrus continues to provide employment, export income and economic opportunities for the communities that depend upon it, while the environmental impacts of producing and moving that citrus around the world are substantially reduced.

Then we work backwards.

Working backwards from that future means asking what would have to change across the whole system to make it possible. How could irrigation in South Africa become less water-intensive, and who should pay for the infrastructure needed to make that happen? What investment would help growers reduce fertiliser and pesticide use or move packhouses towards cleaner energy?

But what would also need to change further along the chain? Could shipping, refrigeration and port logistics become less carbon intensive? Could supermarkets in the United States, Britain and Europe change how they source, price and promote imported fruit? Could trade and purchasing arrangements reward lower-impact production and better working conditions rather than simply cheaper fruit? And how might consumers, retailers and governments in importing countries share some of the costs of making that transition possible? These are the kinds of changes across production, trade, infrastructure, consumption and public policy that working backwards from the future brings into view.

Seen from this perspective, the environmental impact of that orange is not simply a South African problem. It is produced through a global system. Countries already struggling with poverty and inequality cannot be expected to bear the costs of transforming that system alone, nor should transition come at the expense of the people whose livelihoods currently depend upon it.

The challenge is to change the relationships themselves. Carbon, employment, water, land, chemicals, shipping, trade, consumption and inequality are all part of the same entanglement. The orange may be South African, but the system that produces, ships, sells and consumes it is global. The transition therefore has to be global too.

One person in my group chat looked at an orange and suddenly saw a global connection.

The other looked at the same orange and saw carbon.

Both saw something real.

But one strand of a tangle is not the entire entanglement.

The problem isn't the orange.

The problem is how all of these things have become entangled in ways that cannot be addressed through a simple choice to buy or not buy. They require us to rethink the entanglement itself.

The challenge of a just transition is to see our entanglements in more complex and sophisticated ways, so that as we seek to un(re)tangle them, we reduce environmental harm without reproducing social and economic injustice.

 

 

 

 

'Displaced Memory' at Return 02: Group Art Exhibition in Glasgow and Japan About Memory, Place and Entanglement

A big thank you to curator Bowen Wu and the wider Return 02 team — Directors of Curatorial Affairs Ning Hu and Yaney Tang, Assistant Curators Ivy Wei and Jiahui Huang, and publication designer Sirui Zhang — for including my moving-image work Displaced Memory in the exhibition. And thank you to Molend Art in Glasgow and KONspace 101 in Tokyo for bringing the exhibition together across two countries. 

Return 02 (28 - 30 September 2026) is a show simultaneously run in Glasgow and Tokyo. 

 

The exhibition brought together thirteen international artists working across painting, moving image, digital art, installation, glass, printmaking and mixed media.

 

In addition to myself, the other arists included: Baoyue Zhang, Clare Schouten, Claudia Ungersbäck, Esha Malik, Hengtai Zhang, Herbert Neuwirth, Jiawei Yu, Josie Johnson, Leon Crayfish, Monika Tkaczyk, Sofia On and Vincent Corrèze. 

 

CLICK HERE for a PDF of the show and links to the works of the other artists.

 

RETURN O2

The idea behind Return is deceptively simple. What does it mean to return? Not simply to a place, but to a memory, a language, a relationship, a family history, a culture, or even an earlier version of ourselves?

 

Following Return 01, which focused on bodily awareness, emotion and our place in the world, Return 02 moved outward to explore how individual experience connects with wider cultural life through language, family, place and everyday experience. Appropriately, it did so across two very different cultural settings, with the exhibition taking place simultaneously in Glasgow and Tokyo. booklet

 

Across the exhibition, return took many forms: memories of places once lived, inherited cultural traditions, migration and diaspora, family separation, language, landscape, identity and imagined futures. What I particularly liked was that return was not treated simply as going backwards. Memory changes. Places change. Relationships change. We change. What returns is therefore never quite what was there before.

 

Displaced Memory

My contribution was a 90-second moving-image mixed-media work called Displaced Memory. 

 

What is memory, self, place, language? In the final stages of my mother’s dementia, everything blurred together or disappeared. Music was a way to communicate; she loved to sing. Born in the States, the daughter of immigrants from Slovakia. Me, now living in the UK, a new immigrant, caring for my mother from abroad, sorting out the distance and its fracture. On a video call at her skilled nursing facility, her singing Slovak Christmas songs, returning to a language I don’t speak, and to a time and place lost to the past. My brother by her side, my daughter sitting next to me, listening, and me recording it all three thousand miles away, knowing it will all just be a memory (displaced) very soon.

(NOTE: Adjust YouTube settings to HQ 1080 to get the best image and sound) 

 

Displaced Memory connects directly to Return 02 through its exploration of memory, language and family history and the instability of trying to recover them. For my mother, the Slovak songs become a form of cultural return, partial and displaced: they belong to her inherited past and to my own family history, but to a language I do not speak. Yet, now, a way to connect. Living in the UK, that earlier world is also beginning to blur for me and my family. We find ourselves telling the stories of our past again and again as our own cultural rapprochement, a way of reconciling where we came from with the life we have made in a new country. 

 

The recording preserves a trace of a moment already slipping into memory. 

 

The moving-image work reconstructs the moment through sound, portraiture and digital imagery, centred on a mind-like tangle of spheres and connections that gives visual form to language, place, and self as entangled, even as those connections shift, blur or disappear.

 

CLICK HERE to watch it on YouTube if the link above does not work. 

 

From Entanglement to Environmental Health: Proceedings and a First Look at a Forthcoming Book on Complexity

Over the last couple of years, I have been developing the idea of entanglement as part of a book I am currently writing, appropriately called Entanglement. The book develops entanglement as a mechanistic concept for understanding complexity and draws heavily on my visual arts practice as a way of exploring and explaining what entanglement is, how it works and what it looks like. 

 

As I have started using the concept more widely in my scientific and artistic work, and lecturing and presenting on it internationally, people have increasingly asked me if there is something they can read, share and cite. The book is still being written, but my recent public lecture at Nelson Mandela University gave me an opportunity to bring many of these ideas together and work through them in a more developed form. So, rather than wait for the book, I decided to write up the lecture as a first introduction to some of the central ideas.

 

CLICK HERE FOR A PDF OF THE PROCEEDINGS AND CITE AS FOLLOWS:

 

Castellani, B. (2026). Entangled: How might we reshape our entanglement with theenvironment? ISCIA Public Lecture Proceedings, Nelson Mandela University, Gqeberha, South Africa, 16 September 2026.  

 

 

 

I want to begin by thanking Professor Andrea Hurst, Harsheila Riga and Professor Pamela Maseko, Executive Dean of the Faculty of Humanities, for the opportunity to give the ISCIA Public Lecture at Nelson Mandela University in Gqeberha, South Africa, on 16 September 2026. The lecture was hosted through the SARChI Chair in Identities and Social Cohesion in Africa (ISCIA), led by Andrea, and forms part of a much wider collaboration I have developed with colleagues at Nelson Mandela University over the last several years. In terms of Durham University, where I work, I also want to thank the Wolfson Research Institute for Health and Wellbeing and the Durham Research Methods Centre, for supporting my work and for Jonathan Wistow for traveling with me on this trip. 

 

 

So, what do I mean by entanglement?

 

Entanglement is the process through which things become interconnected and interdependent through repeated interweaving over time. The important point is that entanglement is not simply another way of saying that everything is connected. Things can interact without becoming deeply entangled. Entanglement develops when repeated interactions progressively bind elements together such that they cannot simply be separated or extracted without consequences for the wider configuration. As an entanglement develops, it can also widen across other elements, domains and scales, while deepening as those elements become increasingly embedded in and dependent upon one another.

 

For complexity science, this provides one material explanation for how some forms of emergence occur: repeated interactions can become sufficiently entangled that a new level of organisation develops with properties, capacities and constraints that cannot be reduced to the individual elements. Entanglement also helps distinguish emergence from self-organisation. Self-organisation concerns the development of patterns or order through interaction without central control; entanglement concerns how repeated interactions become interwoven, persistent and difficult to disentangle. Importantly, entanglements can emerge through bottom-up self-organisation, but they can also be deliberately engineered, governed, institutionally maintained or strategically reinforced. Most real-world social systems involve combinations of these processes.

 

The Proceedings

‘Entangled: How might we reshape our entanglement with the environment?’

 

So, what is in the proceedings? Rather than give too much away here, the lecture takes the idea of entanglement and puts it to work on environmental health, urban sustainability and just transitions. It asks why some of our most serious environmental problems remain so difficult to change, even when we know a great deal about what needs to be done. 

 

Along the way, I move from fungal mycelium and marine debris to smartphones, coal and South Africa’s just transition to explore how entanglements form, widen, deepen and persist. I look at their relationship to emergence and self-organisation, why some entanglements become resilient or locked in, and how affordances, perception, imagination and creativity can open up possibilities for doing things differently. Visual complexity and my own artwork run throughout, including my speculative moving-image work When the Tangles Arrived.  

 

The second half turns the question around: if we become entangled, how do we become entangled differently? I develop the idea of dis(re)entanglement — Loosen → Reimagine → Redirect → Reweave — and use examples from South Africa to explore what changing established environmental and social entanglements might actually involve. 

 

I will leave the rest for the proceedings. If you are interested in complexity, environmental health, just transitions, or simply why some things become so difficult to change, have a read.

 

 

CLICK HERE FOR A COPY OF THE PROCEEDINGS

 

The proceedings can be cited as: 

Castellani, B. (2026). Entangled: How might we reshape our entanglement with theenvironment? ISCIA Public Lecture Proceedings, Nelson Mandela University, Gqeberha, South Africa, 16 September 2026. 

 

Which AI, by whom, for whom, and under what conditions? My Keynote at the Cynefin Exploratory: 'Balancing human & AI reasoning in a complex world' Dublin, 1-2 July, 2026

Much thanks to Dave Snowden and the Cynefin team for inviting me to be one of the Eagles at the Cynefin Exploratory, Balancing Human & AI Reasoning in a Complex World, held at Trinity College Dublin on 1–2 July.  

 

The two-day Exploratory was designed to bring together researchers, practitioners, policymakers, and organisational leaders to explore the evolving relationship between human reasoning and AI in situations characterised by complexity and uncertainty. Through a mixture of provocations, dialogue, and collaborative inquiry, the event encouraged participants to move beyond simple narratives about AI and engage with the challenges and opportunities these technologies present for organisations and society.  

 

As one of the event’s Eagles, my role was not to provide answers but to offer a provocation—an idea intended to stimulate discussion and critical reflection. My contribution centred on a simple question that I believe is largely missing from current debates about AI. It was this:

 

 

Which AI, by whom, for whom, and under what conditions?

 

 

 

Here is my argument:

Most debates about AI become too broad too quickly. We ask whether AI is intelligent, creative, biased, dangerous, transformative or beneficial, but those claims only make sense once we specify three things: which AI, for whom, and under what conditions.

 

By ‘which AI’, I mean that LLMs, machine learning and predictive systems, recommendation systems, decision-support tools, autonomous agents, and robotics are not the same thing. They have different histories, capabilities, users, risks and consequences.

 

In terms of 'by whom,' I mean AI does emerge in a vacuum. We need to focus on who creates these technologies, owns them, controls, them, decides what they do, etc. We need to address the sociology of AI technologies in terms of power, inequality, exclusion, discrimination, agency etc. 

 

By ‘for whom’, I mean there is no generic AI user. A civil servant using a decision-support tool, a teenager shaped by TikTok recommendations, a scientist using machine learning, a student using ChatGPT, and a warehouse worker interacting with robotics are not encountering AI in the same way. The benefits and harms are unevenly distributed.

 

By ‘under what conditions’, I mean more than context. Conditions force us to specify the task, setting, stakes, expertise, training, access, free versus paid systems, oversight, accountability, laws, language, culture, institutional pressures, and consequences of failure.

 

So, the point is not to ask whether AI is good or bad in general. The point is to ask what kind of AI, used by whom, for what purpose, under what conditions, and with what consequences.

HERE IS A LINK to the PDF of my presentation

HERE IS A LINK to my artwork

HERE IS A LINK to my academic work  

 

Bringing a Complex Systems Approach to WHO Europe Health Workforce Planning (A Two-Day WHO Collaborative)

I would like to thank Tomas Zapata, Cris Scotter, and their team in the Unit of Health Workforce and Health Services in the WHO Regional Office for Europe (Copenhagen) for the opportunity to engage colleagues from different countries for our two-day event: WHO Europe Health Workforce Planning Collaborative

OVERVIEW OF EVENT 

The collaborative sought to advance an international health workforce learning partnership based on shared challenges, adaptive learning and comparative exchange – something that sits at the forefront of all my current work, namely, we need not only international engagement, but also collaboration to learn from each other!

 

Bringing together participants from different systems and contexts creates an important space not simply to compare workforce challenges, but to collectively explore how health systems might build greater adaptive capacity under conditions of growing complexity and uncertainty.

 

The shared challenge we explored was: how do health workforce planning systems remain adaptive, resilient and sustainable under growing multiple pressures?

 

To facilitate the discussions, I was charged with bringing in a complex systems perspective, including participatory systems mapping and a systems approach to theory of change.

What emerged was striking. Despite major differences in health systems and governance structures, many countries are wrestling with similar dynamics: workforce shortages, burnout, fragmented governance, fiscal constraints, uneven regional capacity, data fragmentation and increasing service complexity. At the same time, countries are experimenting with new approaches centred on prevention, collaborative care, learning systems, digital infrastructure, workforce redesign and adaptive planning.

 

One of the most interesting parts of the workshop was moving beyond simply describing problems and instead asking a more difficult question: what actually helps systems adapt under complex conditions? To support this discussion, we developed a working, complexity-informed theory of change and then used participatory systems mapping to collaboratively explore the interacting pressures, feedback loops, leverage points and adaptive capacities shaping workforce planning across contexts.

 

Perhaps the clearest lesson from the discussions is that no country is solving these challenges through single interventions or simple technical fixes. Workforce planning increasingly looks less like a forecasting exercise and more like the governance of a complex adaptive system—one that depends on learning, coordination, institutional memory, trust and the ability to adapt under uncertainty.