This week I gave a short address at a panel debate on the future of care, hosted by frequent client, the rather forward-thinking Freeths solicitors. Here’s what I said. Or at least, what I intended to say when I wrote my script.
When you’re looking to the future, you need to understand two factors. Firstly, what are the pressure points that the sector you are examining is facing today? In my experience, these are always the points of failure or opportunity where change happens first. Secondly, you need to understand what is causing that change. What are the major trends?
For me, the best way to understand those trends is to look at technology. Technology is the means by which we enact change. Described in the broadest terms, technology the application of our understanding of the world. From the first rock a caveman or woman sharpened, through language, to the modern smartphone.
You’re all familiar with the pressure points facing the care sector today. Rising demand, declining budgets, and a catastrophic lack of skilled permanent staff. The demographic changes we’re facing mean the areas with the most demand often have the least access to staff.
Throughout history, technology has been deployed to address issues like this. If you can mechanise a process, you can repeat it at lower cost and higher frequency with fewer staff. It doesn’t matter if it’s a steam powered loom or a computerised call centre. But can we really apply technology to replace skilled people in care? For me, the answer is a very strongly qualified ‘yes’.
First of all, let me tell you what we won’t see, which is some form of robot nurse, capable of all the things a person can do. Human beings are extraordinarily adaptable, both physically and mentally, and this flexibility is enormously challenging — and expensive — to try to replicate.
Rather, what we will see is a much more distributed and pervasive suite of technologies designed to help people support themselves better, for longer. To smooth their entry into more formal care settings. And to assist them in overcoming their challenges throughout.
I’ll start with the first category — what we might loosely term remote monitoring.
Have all heard the buzzphrase, the internet of things? How about Moore’s Law? What this really means is that the price of adding computing power and connectivity to just about anything has collapsed over the last fifty years — even the last decade. And at the same time, the accessibility of the devices and the knowledge to do this has dramatically increased. You can now, with really only a junior school education, programme a machine to monitor basic environmental factors such as temperature and humidity, and send that information off over the Internet. That device might cost you five pounds.
Scale this up and add some grown-up intelligence, and you can start to monitor more things: activity, energy consumption, carbon dioxide levels, doors opening and closing. You can know if someone is active and what sort of conditions they’re living in.
None of this is new, you might say. We’ve been able to get this information over a phone line for years. Sure. But two things have changed. Firstly, the cost: it now costs less than £5 a month to monitor basic environment factors and activity in someone’s home. The hardware is so cheap that there is no up-front cost. And it’s all battery powered so you don’t even need a specialist installer. It can just be stuck to a wall or ceiling, just like the fire brigade installs smoke alarms.
Secondly, intelligence. Computing power is so cheap now that we can throw enormous amounts at monitoring and interpreting this data for very little money. To find the exceptions, the behaviour changes. To identify the risk factors and intervene early — and cheaply — rather than later when the issue is acute.
Over the next few years I think we will see a massive expansion in the application of home monitoring technologies, not just by concerned children but by the state in a bid to manage the costs of care.
The second class of technology I want to talk about is robots. This is perhaps the area that has caused most consternation when its application in the care sector is discussed. People don’t like the idea of a warm nurse being replaced by a cold machine. And I understand that, but we shouldn’t leap to the conclusion that all automata in a care setting are bad.
I have a sideline reviewing gadgets for the BBC, and before Christmas I got sent a Cozmo to play with. Did anyone’s kids get one of these for Christmas? Lucky kids. This is a tiny toy that looks a little bit like a cross between Wall-E and a forklift truck. It borrows the incredible processing power of your smartphone to approximate an artificial intelligence. It can recognise your face and play a series of games with you, using some special cubes that come with it.
The most interesting thing about this toy for me was not the level of tech packed into its tiny shell, but the way that my children projected an identity onto it. This shouldn’t have surprised me. It’s a very human trait: we anthropomorphise everything. Just look how much intelligence and personality we ascribe to our pets, or kids do to totally inanimate dolls.
In a very short space of time my kids created a connection to Cozmo and clearly felt a real sense of reward from interactions with it. The same behaviour has been witnessed in adults interacting with automata in a care setting.
Machines can’t care. But they can provide mental support and stimulation. They can answer questions, guide people, control the environment and entertainment, and increasingly, chat. We can even project a level of love and companionship onto them — even when we know deep down that they are not capable of reciprocating. Because this is clearly what the human brain does. We shouldn’t reject that possibility out of hand.
Augmentation: Physical and mental
What these robots can also do is collect information, store it, and replay it. This is something that we all struggle with, particularly as we age or if our mental faculties are starting to decline. There’s a serious opportunity for us to start to augment our minds with technology. In fact I’ve been arguing for a few years that the process has already started: we are all bionic now.
How many people used a smartphone to get here, looking up the time or location, using GPS and maps? I was born with a terrible memory and basically without a sense of direction, so the advent of such technology has been an absolute boon for me.
Imagine if you could make the interface to this information even more natural. So low friction that you barely notice where you end, and the machine begins. Take these inserts for the sole of your shoe, for example, which vibrate to tell you when to turn left or right. Imagine a verbal prompt through a bone-conducting earpiece. Imagine a digital overlay on your vision.
All of these things are real today or within a few years. They are still both expensive and a little rough around the edges, but that Moore’s Law I talked about will make them widely accessible. I’m betting that this technology is what ultimately replaces the smartphone.
This doesn’t help those with physical frailty of course, but here again, Moore’s Law is our friend. Just ten years ago, strength augmenting suits were the stuff of science-fiction and military fantasies. Now they are commercially available, both in commercial contexts and to help the paralysed to walk again. In another decade or two, as battery and motor technology continues to improve, it’s easy to see articulated walking frames helping people to recover mobility. We’ve already seen such a revolution happen: how many mobility scooters do you remember seeing 20 years ago?
Technology is not the answer to our care crisis. That requires political intervention to raise funding and wages, improve conditions, overcome the looming threat that Brexit presents, and to address the threat to employment and employment quality that technology also so clearly presents. But whether or not these interventions are made, technology represents an opportunity to improve care. To give people more self-sufficient lives for longer, to ensure earlier interventions when they are needed, and even to provide a level of companionship to those who need it. I’d argue that we need to overcome our squeamishness and embrace it.