LSE Business Review Wed, 20 Nov 2019 05:00:03 GMT language
The idea that technology and the digital revolution will transform our lives and be wholly positive is a familiar trope. Undoubtedly the pace of change is rapid – especially since the arrival of high-speed internet connectivity – and the emergence of interactive and voice-activated devices has progressed from the possible to the common place in very short order. The implications not only for our leisure time and entertainment, but also for practical applications in our lives are seemingly boundless. From apps to control our heating, lighting and home security systems; electric vehicles, to ‘swipe to pay’ or ‘tap to activate’ travel permits, the possibilities are rapidly evolving.
The potential for technology to become an increasingly important and routine part of health and care applications is also evident. Robotics are already a feature of complex and sophisticated keyhole surgery, operated by a surgeon via a computer console, and likely to become increasingly common. Not only do they allow great precision, but they expand the boundaries of minimally invasive surgery which produce better outcomes for patients and enable shorter hospital in-patient admissions. However, the use of robotics is not a substitute for skilled surgeons, so much as offering an additional level of specialist instruments and tools. We are a long way from surgical robots operating entirely autonomously.
In social care, the increasing use of assistive technology in the form of such things as stair lifts; computer communication; alarm systems, falls and movement detectors, and GPS alerts to enable tracking of people with dementia or other vulnerable adults, are also all part of the resources that can help in maintaining people’s safety and independence. Robotic interactive companion cat and dog pets are also becoming more familiar, particularly in providing support and comfort to people living with dementia in their own homes or in residential care.
All of these examples, and more, point to the increasing importance of technology within our daily lives, and the potential for them to enhance approaches to care and health, both through using existing mainstream technologies and developing specific apps and devices for health and care requirements. However, this is a considerable distance from the vision outlined at the end of October in a press release from the Department for Business, Energy and Industrial Strategy extolling the future of care robots which might “fulfil tasks such as helping an elderly person up after a fall and raising the alarm, delivering food to an older person at mealtimes, and even ensuring they take crucial medication at the correct time.”
Is this really a vision of the future that we wish to promote, or is it a cautionary glimpse of a dystopian world which separates people’s practical and emotional needs with little concern? The potential of robotics may be considerable, but so too are the moral issues which arise, and questions about the desirability of meeting care needs with little or no human interaction. High-tech solutions are not the automatic answer for needs which are essentially high touch in nature. People’s needs for care and support are not just a set of instrumental tasks; research evidence identifies the quality of contact between people providing support to those needing help (and to their carers) is vitally important; ‘how’ care is delivered is at least as important as ‘what’ is actually provided. The need for kindness and empathy, for genuine care and companionship, for gentleness and warmth and for human contact are the essential features of social care that matter most both to those providing and receiving it. These are the same qualities that are threatened by time and task commissioning of home care that reduces the interaction to the components of care giving which can be delivered efficiently, in minimum time and with little opportunity for any meaningful engagement. To seek to further dehumanise these interactions by use of robotic support is a worrying development indeed.
A 2018 briefing by the Parliamentary Office of Science and Technology on robotics in social care summed up the tricky balance of costs and benefits in these terms:
“Robotics may free up time for caregivers enabling them to focus on delivering a better service for care recipients. However, there are concerns that social care quality may diminish with the use of robots, because robots are incapable of fulfilling the social or emotional needs of older care recipients and may increase loneliness and isolation amongst this group.”
As the briefing also pointed out, the increased use of robotics raises multiple ethical, legal and regulatory issues, not least around the impact on people’s autonomy and privacy, and over the use and ownership of data.
Undoubtedly there is scope for further development of assistive technology, but who decides on the direction of travel is critical. Moreover, this will not be a simple technical fix that works for everyone; the needs of older people with dementia for example, will be quite different from those of a younger disabled adult. While technology and user-controlled devices might be liberating for the latter, they might be totally disempowering and alienating for the former. Some generational or cohort differences might disappear over time, but there are still likely to be significant variations in what people are comfortable in using to assist them, and the extent to which people are able to exercise informed consent. Moreover, much of the development of care robotics has taken place in Japan, and it cannot be assumed that a similar model can be exported wholesale to the UK or other countries without consideration of major cultural variations, and differences in the attitudes to technology in society more widely.
The future of social care is increasingly urgent, in terms of securing a sustainable long-term funding model, but also in clarifying the model of care and the associated values which are to be pursued. In the run up to the December general election, all the parties will be offering their solutions with more or less detail. It is probable that the role of technology will be a key theme within these manifestos. We should approach some of these utopian visions with caution if not scepticism; the role and contribution of technology and robotics to care and health will continue to expand but it does not offer a panacea to the essential need for human touch and compassion. The direction of development therefore needs to be clearly understood and shaped; it should be values-led not technology-driven. The fact that more things are technically possible does not automatically make their introduction either desirable or benign.
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- Featured image by tmeier1964, under a Pixabay licence
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Melanie Henwood is an independent research consultant investigating the interface of health and social care. Her recent work reflects particular interests in carers; person-centred care; the situation of self-funders; and the potential of strengths and asset-based approaches. Melanie was an undergraduate at the University of Kent, where she was also awarded her PhD in social policy. She is an associate of the University of Birmingham’s Health Services Management Centre.